Pelvic Prolapse

When a woman’s pelvic floor muscles are stretched or weakened, the pelvic organs (the bladder, uterus, small intestines and rectum) can shift out of position or sag through the layer of muscles and ligaments, resulting in a condition known as prolapse. It may be helpful to think of prolapse as hernia of the vagina.

There are several types of prolapse:

• Cystocele: the bladder falls into the vagina
• Uterine Prolapse: the cervix and uterus fall down into the vagina
• Vaginal Prolapse: in severe cases of uterine prolapse, the vagina may fall out of the body too
• Enterocele: the small intestine falls down into the vagina
• Rectocele: the rectum/large intestine falls forward on the vagina
• Rectal Prolapse: the rectum falls through the anus. Can occur in men too.

Women who have had multiple pregnancies or given birth vaginally are at higher risk for prolapsed organs. However, prolapse can also occur in women who have never given birth. Heavy lifting, coughing often, obesity, menopause and previous pelvic surgery can also be associated with prolapse.

Symptoms of prolapse include:

• The need to urinate frequently or right away
• Incontinence or urinary leakage
• Not feeling empty immediately after urinating
• Frequent urinary tract infections
• Discomfort or pain in the vagina, pelvis, lower abdomen, groin or lower back
• Painful intercourse
• In severe cases, you may even see a bulging in the vaginal area

A doctor can usually diagnose pelvic organ prolapse by performing a pelvic exam. Other exams or studies may help your doctor assess symptoms associated with prolapse.

Pelvic Prolapse Treatment

In most cases, prolapse can be easily corrected.

• Pelvic Floor Muscle Exercises or pelvic floor physical therapy may resolve the mild prolapse cases
• Estrogen Replacement Therapy applied directly to the vagina can restore the health of pelvic organ tissues and improve prolapse problems. Estrogen replacement therapy may be given in conjunction with other prolapse treatments.
• A Pessary is a removable silicone device that is inserted into the vagina to help hold organs in place. Pessaries come in many sizes and shapes and can be fitted to help women with different degrees and types of prolapse.
• Surgery is usually required for cases that cannot be managed with a pessary or a patient does not want a pessary. Depending on the organs involved, your urologist and gynecologist may coordinate their schedules to perform a combined operation.

What is the difference between a “female urologist” and a urogynecologist?

A urologist is a physician who has completed medical school and a five-year residency program specifically in Urology.  The training includes conditions of the male and female reproductive and urinary tracts, as well as surgical and non-surgical treatment of the urinary system and pelvic floor.  Urologists also have training in various cancers which can occur in the genitourinary system.  Often urologists who specialize in treating women have completed an additional one to two-year fellowship program in pelvic floor disorders.  In contrast, a urogynecologist is a physician who has completed medical school and a four-year residency in obstetrics and gynecology then received additional training in surgical and non-surgical treatment of pelvic floor disorders.