Pelvic Organ Prolapse

Pelvic Organ Prolapse occurs when the pelvic organs (bladder, uterus, vagina and rectum) fall downward and bulge out through the opening of the vagina.

Nearly half of all women between the ages 50 to 79 years old have some form of prolapse, according to the American Urogynecologic Society.

The physicians of the Pelvic Floor Disorders Clinic at the University of Michigan Von Voigtlander Women’s Hospital provide comprehensive surgical and non-surgical services for women suffering from pelvic organ prolapse.

With pelvic organ prolapse, ligaments and connective tissue in the pelvic area become weak or damaged and can no longer support the pelvic organs. Prolapse is sometimes compared to developing a hernia of the vaginal wall. The womb (uterus) is the only organ that actually falls into the vagina. When the bladder and bowel slip out of place, they push up against the walls of the vagina. While prolapse is not considered a life threatening condition, it may cause a great deal of discomfort and distress. Women report to us that this is bothersome to them because their anatomy isn’t normal, they feel too uncomfortable to exercise or the bladder or bowels don’t work the same as they used to.

We treat all types of prolapse:

  • Cystocele - when the bladder pushes against the vaginal wall
  • Uterine prolapse - when the womb slides down the vaginal canal
  • Vaginal vault prolapse - when the top portion of the vagina slides down the vaginal canal after the uterus is removed during a hysterectomy
  • Enterocele - when the small bowel pushes against the vagina
  • Rectocele - when the rectum bulges upward into the vaginal canal

Because prolapse happens due to problems with the pelvic floor, it can develop at multiple sites. It is very common to have more than one type of prolapse the same time. No prolapse will fall completely outside the body and detach itself. Prolapse is not considered a life-threatening condition, but it can greatly damage a woman’s quality of life.

Causes of pelvic organ prolapse

Many different factors may increase the risk of developing pelvic organ prolapse such as vaginal deliveries, use of forceps during vaginal delivery, family history of prolapse, menopause, heavy lifting, obesity, chronic coughing from smoking, asthma or chronic bronchitis, neurologic diseases and/or ethnicity/race.

Symptoms of pelvic organ prolapse

Symptoms of pelvic prolapse may include:

  • bulging or pressure from the vagina
  • a sense that something is falling out
  • pelvic pressure
  • urine leakage, frequency, chronic urinary tract infections, difficulty urinating
  • difficult bowel movements or trapping of stool
  • lower backache

Women with pelvic organ prolapse can experience all, some or none of these symptoms.

In addition, it’s not uncommon for women with pelvic organ prolapse often feel alone, isolated and depressed. You are not alone! Nearly one in nine women will have surgery for prolapse or incontinence, and many others are using non-surgical treatments. Even more women are suffering in silence. Don’t be one of those women – the University of Michigan Pelvic Floor Disorders Clinic is here to help you feel better.

Diagnosing pelvic organ prolapse

A pelvic exam is necessary to diagnose pelvic organ prolapse. If you do have prolapse, the urogynecologist will determine which organs are involved and how severe the prolapse is. Other tests might be ordered, based on your individual examination.

Pelvic organ prolapse treatment

Our treatment approach is focused on the underlying causes of pelvic organ dysfunction.  Our decades of leading renowned research into pelvic organ disorders translates into our being uniquely well qualified to treat the causes of prolapse and not just the symptoms.

Treatment options for each woman will also vary based on the severity and discomfort of the prolapse.

Three main choices exist for the treatment of prolapse:

  • Conservative monitoring – if your prolapse is not bothersome, no treatment is necessary and your gynecologist can monitor progression during your annual exam
  • A pessary can be fit during an office exam to help hold up the organs. Pessaries are usually barely noticeable when you are using one, and do not cause infections or pain.
  • Surgery can restore the pelvic anatomy and correct the bulge.  Surgery can be done vaginally or abdominally, and we offer special expertise in minimally-invasive and robotic surgical techniques. This means we almost never have to make a big incision on your abdomen, and women report a high degree of satisfaction with their results.

If you choose to do nothing for now or wear a pessary, your sex life shouldn't change except you would have to remove the pessary prior to intercourse. It is safe to have sex if you have prolapse.  If you choose to have surgery, you will be asked to wait to have intercourse after that surgery for a period of time. After they have healed, many patients report an improved sex life.

In some cases, the treatment options offered to a woman with prolapse depend on the training and experience of the surgeon. Our group of board-certified Female Pelvic Medicine and Reconstructive Surgery (FPMRS) subspecialists have deep, broad experience with the full range of treatment options for women with pelvic floor disorders and will work with you to find the right option for you.

Take the next step

To schedule an appointment or learn more about the Michigan Medicine Urogynecology Program, call one of our four clinics in Ann Arbor, Northville and Midland.