Pelvic organ prolapse occurs when a pelvic organ drops (prolapses) from its normal spot in the lower pelvis and pushes against the walls of the vagina. This can happen when the muscles and ligaments that hold the pelvic organs in place are stretched or weakened, often as a result of obesity or childbirth. Prolapse is not dangerous, but can cause symptoms of pressure and difficulty emptying the bladder and/or bowels.
UC San Diego Health female pelvic medicine specialists provide both nonsurgical and surgical treatments for pelvic floor prolapse, with nonsurgical treatments always being the first line of approach.
Nonsurgical Approaches for Pelvic Floor Prolapse
- Pelvic floor physical therapy, such as Kegels, to strengthen and tone the pelvic muscles
- Vaginal inserts or pessaries placed into the vagina to provide support for the uterus, bladder, urethra and rectum. A number of types are available and the inserts are fitted to meet your needs.
Surgical Approaches for Pelvic Floor Prolapse
If surgery is needed, your surgeon will discuss options with you. Some of the common types of prolapse and their surgical treatments include:
Bladder prolapse (cystocele): This is when the front wall of the vagina is stretched. To fix this, the vagina is generally repaired by pinching the weakened tissue together. The extra skin is trimmed and the prolapse reduced. This procedure can generally be performed as an outpatient procedure and may be combined with other needed repairs.
Uterine prolapse: This is when the uterus sags past the opening of the vagina. To fix this, the uterus is often removed (hysterectomy) and the top of the vagina suspended to ligaments inside the pelvis (uterosacral vault suspension.) Another option involves keeping the uterus and sewing it back into place to the sacrospinous ligament, with or without mesh graft material.
Vaginal vault prolapse: This is when the walls of the vagina sag past the vaginal opening. It can happen if the uterus has been surgically removed without specific support to ligaments in the pelvis. In this case, surgery can be done to lift the vagina and hold it into place. There are several ways to do this, and UC San Diego Health is involved in clinical trials to understand the best treatment approaches for this condition.
Rectocele or enterocele: A rectocele occurs when the back wall of the vagina bulges past the vaginal opening and may result in symptoms of difficulty with bowel movements. An enterocele (much less common) is when the small intestine bulges into the vagina. During surgery, the bulge in the rectum or small intestine can be fixed. This procedure is similar to a bladder prolapse repair and can be performed as an outpatient surgery.