Pelvic Organ Prolapse

Rose Khavari, MD, director of research at Houston Methodist’s Center for Restorative Pelvic Medicine, explains how pelvic organ prolapse occurs, describes prolapse symptoms and provides treatment examples.

Pelvic Organ Prolapse Types

Pelvic organ prolapse, often referred to as a hernia, has a different name, depending on the organ affected:

• Cystocele – also known as bladder prolapse, is one of the most common types of pelvic organ prolapse. A bulge or dropping of the anterior vaginal wall causes the bladder to slip into the bulge 
• Urethrocele – the female urethra slips in the vagina
• Uterine prolapse – the uterus slips in the vagina
• Vaginal prolapse – the vaginal walls begin to drop and cause vagina to turn inside out 
• Vaginal vault prolapse – the vagina’s upper portion loses its shape and slips in the vaginal canal or outside the vagina 
• Rectal prolapse – the rectum turns inside out and protrudes through the anus 
• Enterocele – the small intestines bulge between the uterus and rectum or bulge on the top of the vagina
• Rectocele – the rectum bulges into the posterior vaginal wall
  
  

Pelvic Organ Prolapse Symptoms

• A bulge outside the vagina
• Urination difficulty or frequent need to urinate
• Constipation or difficulty having a bowel movement
• Sensation of something falling out of the vagina
• Stress incontinence
• Frequent urinary tract infections (UTIs)
• Urge incontinence
• Discomfort or pain in the vagina, pelvis, groin or lower abdomen or back
• Vaginal area heaviness or pressure
• Tender or bleeding tissue protruding from the vagina
• Painful intercourse
  
  

Rectal prolapse symptoms include:

• Stool evacuation difficulty
• Chronic pelvic pain
• The rectum protruding through the anus causing:
  
  • Anal pain
  • Anal bleeding and a mass outside the anus
  • Bowel leakage
  • Difficulty controlling gas and stool
• Pelvic Organ Prolapse Diagnosis
• Cystoscopy – allows a doctor to look at the interior lining of the bladder and the urethra
• Intravenous pyelogram (IVP) – shows the size, shape and position of the kidneys, bladder, ureters and urethra
• Computed tomography (CT scan)
• Bladder function tests
• Pelvic floor strength tests
• Magnetic resonance imaging (MRI)
• Ultrasound

Pelvic Organ Prolapse Treatments

• Pelvic floor physical therapy
  
• Pessaries – vaginal support devices
• Reconstructive surgery – restores proper positioning of affected pelvic organs

Danielle Antosh, MD, director of Houston Methodist’s Center for Restorative Pelvic Medicine, describes how pessaries are used to treat patients with pelvic organ prolapse.