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 ages 50–79 have some form of prolapse, according to the American Urogynecologic Society.

The physicians in the Urogynecology Program at University of Michigan Health Von Voigtlander Women’s Hospital provide comprehensive surgical and non-surgical services for people 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. 

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 at the same time. No prolapse will fall completely outside the body and detach itself. While prolapse is not considered a life-threatening condition, it may cause a great deal of discomfort and distress. Prolapse may make exercising uncomfortable and bowel or bladder function may not work the same as they used to.

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 of the vagina or rectum
  • Pelvic pressure
  • Urine leakage, urination frequency, chronic urinary tract infections, difficulty urinating
  • Difficult bowel movements or trapping of stool

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

In addition, it’s not uncommon for people with pelvic organ prolapse to 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 people are suffering in silence. Don’t be one of those people – the physicians in the Urogynecology Program are 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 person will also vary based on the severity and discomfort of the prolapse.

Four 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
  • Pelvic floor physical therapy can be helpful to alleviate or minimize symptoms of prolapse. It also provides patients with tools to prevent progression of symptoms. U-M Health has a team of physical therapists that specializes in pelvic floor therapy. They provide sensitive and individualized care for patients with pelvic floor disorders.
  • A pessary can be fit during an office exam to help hold up the organs. A pessary is a flexible silicone device that fits into your vagina to provide support for your vaginal wall. Pessaries come in several different shapes and sizes. Pessaries are usually barely noticeable 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 patients report a high degree of satisfaction with their results.

It is safe to have sex if you have prolapse. If you choose to monitor your prolapse or decide to wear a pessary, your sex life shouldn't change apart from removing the pessary prior to intercourse. If you choose to have surgery, you will be asked to wait for a period of time after surgery before having intercourse. After taking time to heal, many patients report an improved sex life.

In some cases, the treatment options offered to people 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 those with pelvic floor disorders and will work with you to find the right option.

Make an Appointment

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