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What is Pelvic Organ Prolapse?

September 26, 2016 | Dr. Ray Bologna

The dictionary definition of prolapse is “to slip forward or down,” but pelvic organ prolapse is a broad term that is used to describe a variety of prolapse conditions:

  • Cystocele (bladder/anterior vaginal wall)
  • Enterocele (top of the vagina)
  • Uterine/vaginal (apical prolapse/uterus)
  •  Rectocele (posterior vaginal wall/rectum).

WHAT ARE THE SYMPTOMS OF PROLAPSE?

Women with prolapse have a wide variation in their experience of symptoms.  Some women feel vaginal pressure and notice a bulge coming from their vagina when they wipe after urinating.  Other women may be asymptomatic and not feel anything at all.  Women with a slight drop or bulge may be very aware and bothered by the prolapse, while others with the same amount of prolapse might not even know that it is happening.  Other symptoms can include difficulty placing or retaining a tampon, difficulty emptying the bladder when voiding and pelvic “heaviness.”

Women often ask “how will I know if I have prolapse?” The answer to this question is simple: you will know and if you don’t, it doesn’t matter.  Despite the presence or severity of the symptoms, it can affect a woman’s body image and cause her to feel embarrassed about intimacy. For this reason alone, it is worth considering treatment.

HOW IS PROLAPSE TREATED?

Treatment is based on the severity of the symptoms. With the exception of rare extreme cases, prolapse is not dangerous or harmful. Prolapsed organs may completely invert outside of the vagina, but it will never detach, burst, rupture or separate.  Many physicians don’t even start the conversation about treatment unless the patient is annoyed or bothered by the symptoms.

Treatment for pelvic organ prolapse consists of expectant management (“watch and wait”), surgical repair.  In some cases prolapse will worsen over time and for others, it may not.  Whether it’s a stage 1 or a stage 4 prolapse, the treatment and repair are the same. In short, delaying treatment does not make it harder to repair or recover.

A pessary is a silicone device that comes in many shapes and sizes and is inserted in the vagina much like a diaphragm that is used for contraception. Essentially, the pessary props up the prolapse and helps relieve some of the pressure and bulge symptoms.

Finally, surgery is always an option.  There are a variety of surgical approaches that are recommended based on the type of prolapse and what makes the patient most comfortable (i.e. more or less invasive, mesh or no mesh).

Learn more about Correcting Prolapse.

Find more articles on Prolapse