What is prolapse?
Pelvic prolapse can occur when pelvic connective tissue and muscle tear or weaken. This can cause the pelvic organs to fall into the vagina, much like a hernia. This is referred to sometimes as a “dropped bladder”, “dropped uterus,” or “dropped rectum.” Your provider may have also called this a cystocele, rectocele, or enterocele. You may see or feel a bulge coming out of your vagina.
What causes pelvic prolapse?
Prolapse is caused by a weakening of the vaginal tissue. It is associated with pregnancy and childbirth although can happen in women who have never had children. Prolapse is also associated with aging and menopause, repetitive heavy lifting and conditions that result in chronic cough, chronic constipation, poor tissue, and genetics.
What are the symptoms of prolapse?
Common symptoms of prolapse include pressure from a protrusion or bulge in the vagina which may become more bothersome after walking or standing for long periods of time. It can also cause vaginal dryness, irritation, or spotting from rubbing against clothing. It’s also common to experience urinary incontinence, trouble urinating or with bowel movements, and sexual dysfunction.
How severe is my prolapse?
Many women can have minor prolapse with minimal to no symptoms. For some, their prolapse worsens over time. Your provider will take a complete history and perform a physical examination to determine the severity of your prolapse. For most, the option to treat depends on how much they are bothered by their symptoms. Treatment options range from pelvic floor exercises or physical therapy or exercises, pessary devices, and surgery.
How is pelvic prolapse treated?
Treatment can be categorized into non-surgical and surgical options.
Non-surgical treatment includes pelvic floor exercises which can strengthen the pelvic muscles and improve mild symptoms. Patients can see a specialized therapist who will use a variety of techniques to improve symptoms. A pessary can also be offered as a non-surgical option. This is a device that can be inserted into the vagina in order to lift and prevent the bulge from coming down. Pessaries come in different shapes and sizes and can help with different degrees and types of prolapse. They are fitted by a provider, typically a gynecologist or a urogynecologist.
Regarding surgical options, there is no single best approach for all patients. Your particular surgical approach will depend on many factors. Your surgeon will discuss the various options with you and will recommend the type best suited to your condition and needs.
– Jeanette Rivera, MD, FACOG, FPMRS