Pelvic organ prolapse — sometimes called genital prolapse — is rarely discussed, yet millions of women in the United States suffer from this hidden medical epidemic. The condition occurs when one or more of the pelvic organs — the uterus, bladder, or rectum — slip down from their normal position and either press against the wall of the vagina or protrude into or beyond the vagina.
One of my recent patients described prolapse as,
“My bladder was bulging outside of my body, and if I was on my feet for any significant length of time, or running or jumping, it would fall out even further. I couldn’t live like this any longer.”
These conditions are most common in postmenopausal women who have given birth, but can also occur in younger women and women who have not given birth. It is estimated that at least half the women who have given birth to more than one child have some degree of prolapse.
Prolapse occurs when there is a weakening or a collapsing of the pelvic floor, the structures which hold the pelvic organs in place. Pregnancy and childbirth, menopause and aging, genetics, obesity, repetitive heavy lifting, and certain conditions like chronic coughing can cause significant weakening of the pelvic floor, leading to a prolapse.
There are levels of prolapse severity: first, second, third, and fourth degree prolapse. Many women with minor prolapses, for example, have no or only minor symptoms. Women who aren’t experiencing any problems from the prolapse do not need treatment.
The three most common types of prolapse are a cystocele (bladder prolapse), rectocele (rectal prolapse), or uterine prolapse. The symptoms of each consist of feeling a vaginal bulge or heaviness – usually worse after standing for long periods of time or after lifting heavy objects. Women also may complain of difficulty emptying their bladder or rectum, incontinence, or discomfort during sex.
Many women live with symptoms from a prolapse for years and don’t know that something can be done, or are scared to seek help.
Left untreated, the prolapse can grow to the size of a grapefruit or larger, and it can become painful if the organs pull on the ligaments that connect to the sacrum. It can become dangerous if the prolapse causes blockage in the tubes that attach kidney to bladder, and it can put older women at risk of reduced activity and social isolation.
It’s important for women to know there are treatments available. Some treatments, like lifestyle changes and physical therapy, are considered more conservative in approach and so are generally tried first. Pessaries, a device inserted into the vagina to provide support to the pelvic floor, offer a temporary solution to pregnant women or, in some cases, a permanent solution to women who are not good candidates for surgery.
Surgery carries more risk than less invasive procedures but is often the best treatment for women with more severe prolapses. Surgery is done to repair and reconstruct the pelvic support structures so that the pelvic organs are restored to their normal positions. There are a number of different surgical options and choosing one depends upon which organ(s) have descended, a woman’s age, history of previous pelvic surgery.