When one of your pelvic organs prolapses, it means that your bladder, uterus or rectum has fallen from its usual suspended location in your pelvic cavity to sag or lean on your vagina. There are several different types of pelvic prolapse:
- Uterine prolapse occurs when the uterus drops down onto the top of the vagina.
- Similarly, if you’ve had your uterus removed, vaginal vault prolapse can then happen, where the top of the vagina bulges into the lower vagina.
- Cystocele is the result of your bladder pushing into the front of your vagina.
- Urethrocele is a related defect, where your urethra presses into the front vaginal wall.
- Rectocele occurs when the rectum presses into the back wall of your vagina, sometimes so much so that it interferes with bowel movements.
Pelvic Prolapse Symptoms
You may discover that you have a prolapsed organ when you have your yearly pelvic exam, even though you’ve had no symptoms at all. If your prolapse is more pronounced or severe, though, you may experience a whole range of symptoms, including:
- A heavy sensation or pelvic pressure in your vagina
- A lump bulging out of your vagina that you can see or feel while bathing
- Pressure and pain, mainly in your legs and low back
- Urinary problems from certain prolapses, including stress-induced continence, unusual problems starting to urinate and recurrent urinary tract infections
- Bowel problems, such as pain, pressure and constipation
- Sexual problems that include irritation in your vaginal tissues or pain during sex
Tests to Determine Your Condition
If your prolapsed organ can’t be felt or seen during a physical exam, then your doctor may perform some tests to be sure you have a prolapsed organ. The most helpful tests are the following:
- Bladder function tests, which can measure the pressure within your bladder
- Pelvic floor strength tests, which measures the power of your vaginal muscles
- Magnetic resonance imaging or MRI, which can reveal the extent of your prolapse
- Ultrasound, which provides a picture of your organ placement
Why Organs Prolapse and How to Prevent It
When the muscles in your pelvic floor weaken, as they will with age or after you’ve delivered a baby through your vaginal canal several times, a bulge can begin to appear. This allows other organs to lean, press or push on your vagina. Once one organ falls, the chances of another organ prolapsing rises. Additionally, you are at higher risk if any woman in your immediate family has had a problem with pelvic prolapse. If you’ve corrected a prolapsed organ in the past, you’re also more likely to have it happen again.
You can actually help protect your pelvic floor muscles and tissues, as well as shore them up against future pelvic pain prolapse, by doing the following:
- Stop smoking cigarettes
- Take care of any medical issues that might strain that area, such as constipation or even a chronic cough like a smoker’s cough or an asthmatic cough
- Lose weight so you put less pressure on your reproductive organs
- Avoid heavy lifting
- Exercise to strengthen your core and pelvic muscles, including practicing Kegel exercises, aiming for 30–40 contractions a day
Prolapse Treatment Options
Typically, doctors and patients both want to avoid surgery. If you’ve already discovered a prolapsed organ in the early stages and the prolapse is still mild, you can try these non-surgical approaches with your doctor’s approval:
- Pelvic floor muscle training under the guidance of a pelvic floor physiotherapist or continence nurse that can provide biofeedback
- Biofeedback using a monitoring device, where sensors are placed on your body, in your vagina or in your rectum — the monitoring device can then tell if you’re using the correct muscles when asked to use them, thereby improving the way you perform the exercises
- Avoiding straining too hard when you go to the bathroom and take steps to stop constipation
- Maintaining a diet and fluid intake that assists with bowel movements
- Possibly using a pessary, a plastic device similar to a diaphragm or cervical cap, placed in your vagina to support the organs above or around it — measurements are taken to fit the device to your body
- Lifestyle changes such as exercising regularly and if need be, losing weight
If non-surgical treatments do not help reduce or eliminate your symptoms or if your prolapse is really impacting your quality of life, then you may have no choice but to proceed with prolapsed surgery. Surgery is still not guaranteed to be successful, but it often can alleviate your symptoms. As long as you follow the doctor’s advice on what to do after your surgery, you may be able to avoid another prolapsed organ. Your doctor generally uses one of two types of surgery for pelvic organ prolapse:
- Obliterative surgery, which involves narrowing or completely closing off your vagina to support the upper organs. Once you have this procedure, you’ll be unable to have sexual intercourse in the future. Most women do not choose this option.
- Reconstructive surgery, which attempts to fix the support system that has failed to keep the organs in place. There are several ways for your doctor to do this:
- Fixation or suspension through your vagina, using your own tissues and ligaments to re-create support for the prolapsed organs
- Anterior and posterior colporrhaphy (also known as A&P repair), which is a repair of your vaginal wall to keep your rectum where it belongs — this is done through your vagina
- Sacrocolpopexy, where your vaginal vault is attached to the sacrum
- Sacrohysteropexy, where your prolapsed uterus is corrected by attaching your prolapsed cervix to your sacrum
The last two procedures are performed by your doctor through an incision in your abdomen. Support is provided with a surgical mesh. The benefit to these procedures is that you’ll feel less pain with intercourse afterward. On the other hand, the recovery time for these procedures is longer and mesh is no longer considered as safe as it once was.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult ob/gyn doctor about your specific condition. Only a trained, experienced board certified gynecologist can determine an accurate diagnosis and proper treatment.
Do you have questions about Pelvic Prolapse? Would like to schedule an appointment with the NYC top OBGYN specialist, Dr. Anat Zelmanovich, please contact our office.
Dr. Anat Zelmanovich, Gynecologist (Gynecologist NYC, Midtown OB/GYN)
New York, NY 10010
☎ (212) 533-4575
Dr. Anat Zelmanovich, Gynecologist (Gynecologist NYC, Upper East Side OB/GYN)
New York, NY 10028
☎ (212) 533-4575