Pelvic Organ Prolapse

The uterus is held in position by pelvic muscles, ligaments and other tissues. If the uterus drops out of its normal position, this is called prolapse. Prolapse is defined as a body part falling or slipping out of position. Prolapse happens when the pelvic muscles and connective tissues weaken. The uterus can slip to the extent that it drops partially into the vagina and creates a noticeable lump or bulge. This is called incomplete prolapse. Complete prolapse occurs when the uterus slips to such a degree that some uterine tissue is outside the vagina.

Pelvic prolapse is usually accompanied by some degree of vaginal vault prolapse. Vaginal vault prolapse occurs when the upper part of the vagina loses its shape and sags into the vaginal canal or outside the vagina. Pelvic prolapse may also involve sagging or slipping of other pelvic organs, including the bladder, the urethra which is the tube next to the vagina that allows urine to leave your body, and rectum.

Signs & Symptoms

Women with mild cases of pelvic prolapse may have no noticeable symptoms. However, as the uterus falls further out of position, it can place pressure on other pelvic organs—such as the bladder or bowel — causing a variety of symptoms, including:

  • Sensation of sitting on a small ball
  • Heaviness or pulling in the pelvis
  • Pelvic or abdominal pain
  • Pain during intercourse
  • Protrusion of tissue from the opening of the vagina
  • Repeated bladder infections
  • Vaginal bleeding or an unusual or excessive discharge
  • Constipation
  • Frequent urination or an urgent need to empty your bladder

Causes and Risk Factors

Pelvic prolapse is fairly common and the risk of developing the condition increases with age. It can occur in women who have had one or more vaginal births. Normal aging and lack of estrogen after menopause may also cause pelvic prolapse. Chronic coughing, heavy lifting and obesity increase the pressure on the pelvic floor and may contribute to the condition. Although rare, pelvic prolapse can also be caused by a pelvic tumor. Chronic constipation and the pushing associated with it can worsen pelvic prolapse.

Treatment

Non-Surgical Options

Radiation Therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Hormone Therapy: Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery or radiation therapy are used to reduce the production of hormones or block them from working.

Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Chemotherapy can be either systemic, reaching cancer cells throughout the body via the bloodstream, or regional, targeting cancer cells in specific body parts or areas. The method chosen depends on the type and stage of the cancer being treated.

Surgical Methods

Laparoscopic Pelvic Organ Prolapse Repair: Open abdominal surgery or laparotomy refers to any surgical operation in which the abdomen is opened to access or inspect the organs of the abdominal cavity. Traditionally, surgeons perform the majority of gynecologic surgery using an “open” approach, which is through a wide (6-12 inch) abdominal incision below the navel and through the abdominal muscle wall. The skin incision can be either transverse (horizontal) or vertical. This is the most common type of incision used during C-section. Open abdominal surgery can be painful, involving heavy pain medications, risk of infection, significant blood loss and increased risk for transfusion. After surgery, a long recovery (often 6 weeks) is usually necessary. In addition, many patients are not happy with the scar left by the incision.

While minimally invasive surgery (laparoscopy) has been available for two decades now for many routine gynecologic procedures, most complex hysterectomy, myomectomies and sacrocolpopexies are performed using open surgery. This is because conventional laparoscopic technology can’t provide surgeons the visualization, precision, dexterity and control required to handle challenges like large uteri, multiple adhesions from prior pelvic surgery. Fortunately, today the vast majority of complex gynecologic conditions – from endometriosis to uterine fibroids, prolapse, heavy menstrual bleeding and cancer – can now be treated effectively without a big incision.