Pelvic Prolapse

Pelvic Organ Prolapse

Pelvic organ prolapse is when 1 or more organs inside the pelvis slip from their normal places. The pelvis is found between the waist and thighs. Normally, muscles and tissues in the pelvic region support the pelvic organs and hold them in place.

What is a normal pelvis?

Cutaway view of pelvis showing the small intestine, bladder, pubic bone, urethra, pelvic floor muscles, uterus, vagina, and rectum.

A. The small intestine absorbs nutrients from food.

B. The bladder collects and holds urine.

C. The pubic bone helps protect the pelvic organs.

D. The urethra is the tube that carries urine out of the body.

E. The pelvic floor muscles support organs and other structures in the pelvis.

F. The uterus is where the baby develops when a women is pregnant.

G. The vagina is the canal from the uterus to the outside of the body.

H. The rectum stores stool until a bowel movement occurs.

What causes pelvic organ prolapse? 

There are several causes of pelvic organ prolapse including:

  • Vaginal childbirth

  • Hereditary (genetic) factors

  • Connective tissue disorders

  • Getting older

  • Constant coughing (such as with bronchitis or smoking)

  • Heavy lifting

  • Chronic straining (such as with constipation)

  • Being overweight

What are the symptoms of pelvic organ prolapse?

The symptoms of pelvic organ prolapse include:

  • A feeling of fullness or pressure in your pelvis

  • A sense that a ball or lump is sticking out from the vagina

  • Problems passing urine or having a bowel movement

  • Urine leakage when you cough or use stairs. (But this can happen even without prolapse.) 

  • Pain or pressure in your low back

  • Pain when having sex

Nonsurgical Treatment

Pelvic Organ Prolapse: Nonsurgical Treatment

If your pelvic organ prolapse is mild or doesn’t bother you much, or if you have medical conditions that make surgery too risky, nonsurgical treatment may be a good choice. A device (pessary) to wear in your vagina can help ease your symptoms. You may also be given certain exercises (Kegels) to do. And you may need to make some lifestyle changes.

Wearing a pessary

A pessary helps support the prolapsed organ or organs. It is specifically fitted by your healthcare provider. A pessary may ease your symptoms, but it can’t repair prolapse. The pessary must be removed for cleaning. If you can’t do this, you will need to see your healthcare provider regularly. He or she will remove and clean your pessary. If you have questions or concerns about the pessary, be sure to talk with your provider.

Doing Kegels

Kegels are simple exercises that you can do to strengthen the pelvic floor muscles. They may ease your symptoms and prevent further prolapse. To do a Kegel, contract your pelvic floor muscles as if to stop the urine stream. (Do this when you’re not urinating.) Ask your healthcare provider how many Kegels to do and how long to hold each one. During your treatment visits, your provider may place a device in your vagina to measure your Kegel contractions. That way, you can find out if you are doing Kegel exercises correctly.

Living a healthy life

Improving your health may ease your symptoms or keep your problem from worsening. You may be asked to:

  • Quit smoking to prevent excessive coughing

  • Adjust medicines that may cause urine leakage

  •  Limit fluid intake, if incontinence is a problem. This includes limiting drinks that contain caffeine (a diuretic). Bladder training (emptying your bladder at scheduled times) also may be useful if you have incontinence.

  • Not do any lifting, which puts pressure on pelvic muscles

  • Exercise and eat well to stay at a healthy weight

Surgery for Uterine Prolapse

Pelvic Organ Prolapse: Surgery for Uterine Prolapse

 

Possible risks and complications of prolapse surgery

  • Infection

  • Bleeding

  • Risks of anesthesia

  • Damage to nerves, muscles, or nearby pelvic structures

  • Blood clots

  • Prolapse of the pelvic organ or organs occurring again

Cutaway view of uterus and vagina

The uterus is in the pelvis. If the structures that hold it in place weaken, the uterus can slip from its normal position. This is called uterine prolapse. When this happens, the uterus drops down into the vagina. In severe cases, the uterus can stick out from the vagina. Surgery can be done to fix the problem. This will relieve your symptoms.

Cutaway view of uterus and vagina

The surgical procedure

To fix the prolapse, the uterus is removed. This is called hysterectomy. Then, the vagina is lifted and supported so it stays in place. This type of surgery can be done through the vagina or abdomen. Stitches (sutures) are used to attach the vagina to strong tissue in the pelvis. Sometimes a synthetic material or biologic material is used to reinforce the repair. This supports the top part of the vagina. Other procedures may be done to keep the vagina from slipping again.

Incision site

Incision site

Your incisions

During surgery, the doctor reaches your pelvic organs through the vagina or the abdomen. If the pelvic organs are reached through the vagina, an incision is made in the wall of the vagina. If the pelvic organs are reached through the abdomen, several small incisions are made in the abdomen to insert tiny laparoscopic tools. Or one larger incision is made in the abdomen. The belly incision can be up and down (vertical) or across (transverse).

Providers

Richard F C Hill, MD

Female Pelvic Medicine and Reconstructive Surgery

Saint Luke’s Urogynecology Specialists

Saint Luke’s Hospital’s Urogynecology experts have the specialized experience and skill to evaluate and treat a wide range of pelvic floor disorders.