What is pelvic organ prolapse?

 What is pelvic organ prolapse? What is pelvic organ prolapse? It can be hard talking about intimate heath problems – but pelvic organ prolapse is a condition that affects millions of women. So remember, you’re not alone. Learn more about pelvic organ prolapse

Pelvic organ prolapse occurs when the pelvic muscles and ligaments are weakened, making them unable to hold the pelvic organs in place. The organs can then drop down into the pelvic area.

Women with prolapse often have a sense of heaviness in the vagina or pelvis. They may complain of feeling that they are “sitting on a ball”, or notice a bulge or mass protruding from the vaginal area while showering. Sometimes this feeling of heaviness or bulging is experienced more towards the end of the day, after working or standing all day. Other symptoms include discomfort during intercourse, urinary incontinence and bowel problems.

Some women may attempt to push the prolapsed organ back in to help when urinating, but may notice that the pressure is reduced on its own when they lie down at night. There are several different types of pelvic organ prolapse, with different names depending on the organs involved.

What causes pelvic organ prolapse?

Pelvic organ prolapse occurs when the muscles in the pelvic floor are stretched or aren’t strong enough to hold the pelvic organs in their correct position. It isn’t a life-threatening condition, but can cause pain and discomfort and have a major impact on your day-to-day quality of life.

Things that can cause the muscles in the pelvis to become stretched or weakened include:

  • Pregnancy and childbirth
  • Aging and menopause
  • Obesity
  • Fibroids or pelvic tumors
  • Long-term (chronic) coughing
  • Long-term (chronic) constipation
  • Lifting heavy objects
  • Certain genetic conditions
  • Prior pelvic surgery
  • Some neurological conditions or spinal cord injuries
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What are the different kinds of pelvic organic prolapse? What are the different kinds of pelvic organic prolapse? There are many different types of pelvic organ prolapse. Read more about them here. Read about the different kinds of pelvic organic prolapse

The main types of pelvic organ prolapse are:

Bladder prolapse – Cystocele occurs when the bladder, which stores urine, slips down and pushes against the front of the vagina.

Rectum prolapse – Rectocele occurs when the rectum bulges into the back of the vagina.

Urethra prolapse – Urethrocele occurs when the urethra, which transports urine from the bladder and out of the body, slips and pushes against the lower part of the front of the vagina.

Vaginal vault prolapse – Vaginal vault prolapse occurs when the top of the vagina falls in on itself. This only happens if a woman has had a hysterectomy – an operation to remove the uterus.

Small bowel prolapse – Enterocele occurs when the small intestine drops down between the back of the vagina and the rectum. This may occur at the same time as prolapse of the uterus or rectum.

Uterus prolapse – Uterine prolapse occurs when the uterus (womb) drops down into the vagina.

Your doctor will assess which type of prolapse you may have. It is possible to have more than one type at the same time.

 

Normal female anatomy Cystocele Rectocele Uterine prolapse
Normal female anatomy Cystocele Rectocele Uterine prolapse

How do I know if I have pelvic organ prolapse?

The signs and symptoms of pelvic organ prolapse vary, depending on the type of prolapse and how advanced it is.

Mild prolapse may be experienced as a sensation of pressure or dragging in your pelvic area, particularly if you have been standing for a long time.

As the prolapse becomes more severe, you may feel more discomfort as well as one or more of the following symptoms:

  • Problems controlling your bladder
  • Difficulty urinating
  • Leaking urine during everyday activities that put pressure on your abdomen (stress urinary incontinence)
  • Constipation or other bowel problems
  • Discomfort or pain in your lower pelvis
  • Back pain
  • A feeling that something is stuck or is  falling out of your vagina
  • Discomfort or pain during intercourse
  • A lump in your vagina
  • Unusual bleeding or discharge
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Treatment options

Non-surgical treatment options If you have pelvic organ prolapse, there are treatment options that can make a difference. Read more about these options here. Find out more about Non-surgical treatment options

There are different treatment options available for pelvic organ prolapse. Your doctor will be able to help you find the best solution for you, according to the type and cause of the prolapse. They will also take into account your plans for the future, including whether you would like to become pregnant.

Treatment may start with non-surgical options such as Kegel exercises, a pessary (device worn in the vagina for support), estrogen supplementation, electrical stimulation or biofeedback.

Kegels are exercises that can help strengthen your pelvic floor muscles. In mild cases of uterine prolapse, they may be the only treatment needed. However, for them to be effective, they need to be done daily.

Vaginal pessary is a rubber or plastic device used to support the pelvic floor and the prolapsed organ. A doctor or healthcare professional will insert and fit the pessary, which must be cleaned frequently and removed before sexual intercourse.

Estrogen replacement therapy may help to limit any further weakening of the muscles and connective tissues that support the uterus, bladder and rectum. However, there are some drawbacks to taking estrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer.

You should discuss all treatment options available to you with your doctor.

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Surgical treatment options If you have a severe pelvic organ prolapse, surgery will help repair the situation. Read more about the surgical treatment options

If you need surgery to repair your pelvic organ prolapse, the treatment involves using your own tissue or a graft to repair the pelvic floor. These grafts can be biologics or synthetic mesh that supports the affected organ(s) and have been designed to help relieve the symptoms you have been experiencing.

Coloplast offers unique products that may be prescribed by your doctor for strengthening prolapse repair: Axis™ Dermis and Suspend® Fascia Lata biologics; and Restorelle® synthetic meshes. Restorelle synthetic mesh was created specifically for women's bodies and is composed of a very thin, lightweight mesh made from a soft synthetic polypropylene material. Coloplast grafts combine with your body’s natural tissue to provide extra support. This newly-strengthened support system will help keep the pelvic organs in the correct place. Not every product is right for for every person - treatment decisions must be unique to each individual's medical history, symptoms, and lifestyle.

Talk to your doctor to find out more about surgical options for treating prolapse.

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What happens before, during and after surgery?

What to expect before surgery What to expect before surgery Surgical prolapse repair is not suitable for everybody. Here are some things to discuss with your doctor. Before surgery

Mesh reinforced prolapse repair isn’t suitable for every patient. You will need to have a thorough discussion with your doctor to see if it’s the right option for you, and understand why your surgeon has recommended a specific option.

Potential complications from mesh surgery include pain, mesh infection or non-healing, mesh extrusion from the vagina, mesh erosion into adjacent organs, nerve damage, recurrent prolapse, inflammation, adhesion formation, fistula formation, narrowing of the vagina, scarring, and pain during sexual intercourse.

Other potential complications include bleeding, infection, injury to blood vessels or nerves, or even bladder, urethra or bowel injury during mesh placement – which may require additional surgery. Difficulty urinating or passing stools can also occur, either temporarily or permanently.

It may help to make a list of any questions that you would like to ask your doctor about surgical options for prolapse repair. There is a recommended set of questions to ask your doctor prior to surgery available here. If there is anything that is unclear or you don’t understand, don’t be afraid to ask for an explanation. There is a lot of information to absorb at once, and your doctor will be able to help you get a clear overview.

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What to expect during surgery What to expect during surgery Find out more about what happens during pelvic organ prolapse surgery During surgery

Surgery for pelvic organ prolapse is performed at a hospital under general anesthesia. The mesh is inserted through a small incision through either the abdomen or in the vagina. Mesh is placed to restore prolapsed organs are to their natural position.

Restorelle mesh

Example of Restorelle® mesh. The shape of mesh used during surgery depends on the individual woman’s body structure and the type of prolapse being repaired.  Surgical mesh is a permanent implant.

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What to expect after surgery What to expect after surgery Although every patient’s recovery is different, many patients experience some sort of tiredness or discomfort following surgery. After surgery

In many cases after surgery, you may be able to return home the same day. However, for some, you may be required to stay overnight at the hospital.

It is normal to feel some discomfort and tenderness for a few days afterwards. During your recovery, it’s important not to lift anything heavy or have sexual intercourse, so your body can heal and the new graft material can bind with your own tissues.

It is usually possible to return to normal daily activities and go back to work within 4 to 6 weeks of the surgery. Your doctor will give you specific instructions to follow during your healing process.

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Frequently asked questions

Find answers to common questions about pelvic organ prolapse FAQ for pelvic organ prolapse

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when the pelvic floor muscles become too weak to hold the pelvic organs – the bladder, uterus, vaginal wall or rectum - in place.

 

Can pelvic organ prolapse be successfully treated?

Yes. While pelvic organ prolapse can get worse over time and will not go away on its own, it can be treated.

 

What causes pelvic organ prolapse?

Pregnancy and childbirth are the most common causes of pelvic organ prolapse. However, menopause, previous vaginal surgery, chronic coughing or straining, heavy lifting, obesity, family history and loss of muscle tone as a result of aging can also contribute.

 

What are the treatment options for pelvic organ prolapse?

There are both non-surgical and surgical treatment options. The non-surgical options may include lifestyle changes, Kegel exercises, vaginal pessaries (devices inserted in the vagina) or medications. Surgical treatments are minimally invasive and are designed to help keep the pelvic organs in the correct place by inserting either a biological or synthetic graft. Your doctor can discuss these and other treatment options with you.

 

What is prolapse surgery?

Prolapse surgery is a surgical procedure that uses your own tissue or a graft material (biological or synthetic) to correct the prolapse by placing graft material over the bulge and suturing it into place. The goal is to help keep the pelvic organs in the correct place.

 

How long does it take to recover from prolapse surgery?

Every patient’s recovery time is different. During your recovery, it is important to avoid heavy lifting, exercise and sexual intercourse. Your doctor will be able to provide you with more specific details about your individual recovery process.

 

What are the risks associated with prolapse surgery?

Every surgical procedure carries some risk, and serious complications from prolapse surgery can occur.

Potential complications from mesh surgery include pain, mesh infection or non-healing, mesh extrusion from the vagina, mesh erosion into adjacent organs, nerve damage, recurrent prolapse, inflammation, adhesion formation, fistula formation, narrowing of the vagina, scarring, and pain during sexual intercourse.

Other potential complications include bleeding, infection, injury to blood vessels or nerves, or even bladder, urethra or bowel injury during mesh placement – which may require additional surgery. Difficulty urinating or passing stools can also occur, either temporarily or permanently.

Ask your doctor for more information about potential risks and complications, as well as your specific surgery and situation.

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