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Pelvic Organ Prolapse

Uterine prolapse

Image: uterine prolapse

The network of muscles, ligaments, fascia, and skin around a woman’s vagina acts as a complex support structure that holds pelvic organs and tissues in place. Various parts of this support system may eventually weaken or break, causing a common condition called vaginal or pelvic organ prolapse. An estimated 34 million women worldwide are affected by pelvic organ prolapse.

Vaginal prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse or fall out of their normal positions. Without medical treatment or surgery, these structures may eventually prolapse farther and farther into the vagina or even through the vaginal opening if their support weakens enough.

Symptoms of Prolapse

  • A bulge or lump in the vagina
  • Pulling or stretching feeling in the lower groin area
  • Difficult or painful intercourse
  • Vaginal pain, pressure, irregular bleeding or spotting
  • Frequent need to urinate (overactive bladder)
  • Difficulty emptying the bladder
  • Difficulty emptying bowels
  • A feeling that the bladder is not emptying completely (stress urinary incontinence)
  • Delayed or slow urine stream

What Causes Prolapse?

Prolapse is caused by pelvic muscles and ligaments that have been weakened or damaged over time. The most common causes of prolapse are:

  • Age
  • Childbirth
  • Hysterectomy and other pelvic surgeries
  • Menopause
  • Obesity
  • Strenuous physical activity
  • Family history


Types of Pelvic Organ Prolapse

  • Cystocele – This is a prolapse of the front wall of the vagina that often results in the bladder prolapsing into the vagina. Stress urinary incontinence is a common symptom of a cystocele.
  • Rectocele – This involves a prolapse of the back wall of the vagina. As a result, the rectal wall pushes against the vaginal wall, creating a bulge.
  • Enterocele – When the front and back walls of the vagina separate, the intestines push against the vaginal skin. An enterocele usually occurs following a hysterectomy.
  • Prolapsed uterus – The weakening of a group of ligaments at the top of the vagina cause the uterus to prolapse into the vagina
  • Vaginal vault prolapse – The top of the vagina falls toward the vaginal opening. This type of prolapse may occur following a hysterectomy.

Diagnosing Pelvic Organ Prolapse

Your doctor will begin the diagnostic process by taking a detailed medical history, performing a physical exam and by determining the strength and function of your pelvic floor muscles. Your doctor may also order additional diagnostic testing including:

  • A pelvic ultrasound
  • Bladder function test
  • Urodynamic testing, which are diagnostic tests that evaluate the function of the bladder and urethra and include uroflow, cystometrogram, EMG, pressure flow study, or videourodynamics.

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