Incontinence & Pelvic Floor Disorders
Pelvic Organ Prolapse
Pelvic organ prolapse is a medical condition that occurs when the normal support of the vagina is lost, resulting in "sagging" or dropping of the bladder, urethra, cervix and rectum. As the prolapse of the vagina and uterus progresses, women can feel bulging tissue protruding through the opening of the vagina. Prolapse is not life threatening but it can be uncomfortable and sometimes makes it hard for women to empty their bladders normally or even exercise.
It is estimated that nearly 50% of all women between the ages of 50 and 79 have some form of prolapse.
- Some women are born with weaker tissues and are therefore at risk to develop prolapse.
- Caucasian women are more likely than African American women to develop pelvic organ prolapse.
- Loss of pelvic support can occur when any part of the pelvic floor is injured during vaginal delivery, surgery, pelvic radiation or back and pelvic fractures during falls or motor vehicle accidents.
- Hysterectomy and other procedures done to treat pelvic organ prolapse also are associated with future development of prolapse.
- Some other conditions that promote prolapse include: constipation and chronic straining, smoking, chronic coughing and heavy lifting.
- Obesity, like smoking, is one of the few modifiable risk factors.
- Women who are obese have a 40 to 75% increased risk of pelvic organ prolapse. Aging, menopause, debilitating nerve and muscle diseases contribute to the deterioration of pelvic floor strength and the development of prolapse.
Upon physical examination, some loss of support is very common in women who don't have bothersome symptoms. Those women who are uncomfortable often describe the very first signs as subtle—such as an inability to keep a tampon inside the vagina, dampness in underwear or discomfort due to dryness during intercourse.
As the prolapse gets worse, some women complain of:
- A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements.
- The feeling that they are "sitting on a ball".
- Needing to push stool out of the rectum by placing their fingers into the vagina during bowel movement.
- Difficulty starting to urinate, a weak or spraying stream of urine.
- Urinary frequency or the sensation that they are not emptying their bladder well.
- The need to lift up the bulging vagina or uterus to start urination.
- Urine leakage with intercourse
There are many treatment options available. For most women, the treatment they choose depends on how much they are bothered by their symptoms. Many conservative treatment options are available including pelvic floor rehabilitation. One treatment for pelvic organ prolapse is a device inserted into the vagina called a pessary. A pessary is a plastic ring, similar to a vaginal contraceptive diaphragm, which is used to either lift the bladder or to apply some compression to the urethra during activities that are known to cause leakage. Finally, some women are bothered by their pelvic organ prolapse enough to consider surgery. Only you and your doctor can determine what treatment option is best for you.
Doctors on staff at Silver Cross who treat pelvic organ prolapse include: