Page modified at: 23/11/2009
What does "prolapse" mean?
The word prolapse simply means displacement from the normal position. When this word is used to describe the female organs, it usually means bulging, sagging or falling. It can occur quickly, but usually happens over the course of many years.
What is a Pelvic Organ Prolapse?
There are several types of pelvic organ prolapse. Patients may have more than one, because pelvic organs are interrelated.
Prolapse of the Rectum (Rectocele)
A prolapse of the rectal wall (back wall of the vagina).
When this wall weakens, it pushes against the vaginal wall, creating a bulge, which may become noticeable during bowel movements.
It is different from rectal prolapse because it involves weakness in the tissues between the vagina and rectum.
Prolapse of the Bladder (Cystocele)
This "bladder drop" occurs when the front wall of the vagina prolapses.
In many instances, it is accompanied by prolapse of the urethra (urethocele).
When they occur together, the result is cystourethrocele.
A common symptom of bladder or urethra prolapse is urinary stress incontinence (leaking of urine); for instance, while running, sneezing or coughing — although in more advanced cases the prolapse may actually obstruct urine.
Prolapse of the Uterus (Uterine Descensus)
A group of ligaments at the top of the vagina weaken, causing the uterus to fall. This causes the front and back walls of the vagina to weaken as well.
The condition has several stages — from the first degree when the uterus drops into the upper portion of the vagina, to the fourth degree when it protrudes outside of the vagina.
Prolapse of the Vaginal Vault and Herniated Small Bowel (Enterocele)
With vaginal vault prolapse, the top of the vagina may fall toward the vaginal opening.
It usually results from herniated small bowel — a weakening of the vaginal supports, which causes the front and back walls of the vagina to separate and the intestines to push against the vaginal skin.
Vaginal vault prolapse is likely to occur after a hysterectomy (removal of uterus) because the uterus provides support for the top of the vagina.
Many patients with these types of prolapse have urinary incontinence; testing can further evaluate the anatomy and function of the pelvic floor.
What symptoms are caused by my prolapse?
The symptoms depend on which type of prolapse you have. Since prolapse usually occurs slowly over time, the symptoms can be hard to recognize.
Most women don't seek treatment until they actually feel something protruding outside of their vagina. The very first signs can be subtle - such as pain during intercourse or an inability to keep a tampon inside the vagina. As the prolapse gets worse, some women complain of a bulging or heavy sensation in the vagina that worsens by the end of the day or during bowel movements.
Some women with severe prolapse even have to push stools out of the rectum by placing their fingers into the vagina during bowel movements.
Why did this happen to me? Did I do something to cause this problem?
There are many factors that seem to contribute to the development of prolapse, and almost none of them are things you can control. Genetics definitely plays a major role.
Vaginal deliveries can predispose certain women to develop prolapse, but we haven't learned how to identify these women BEFORE they have children.
Other conditions that seem to go along with the development of prolapse are severe obesity, pelvic tumors and chronic constipation. Repetitive heavy lifting may contribute to prolapse as well.
Do I necessarily need to have surgery for my prolapse? NO.
There are two other choices - to do nothing about it or wear a pessary. A pessary is worn in the vagina like a diaphragm. Pessaries come in many different shapes and sizes all designed to support the prolapsed pelvic organs. Pessaries are used to support the vagina, bladder, rectum and uterus as necessary. They come in a variety of shapes and sizes, so a doctor or nurse must fit them. Many women are completely satisfied using a pessary for years - avoiding surgery all together.
If I choose to use a pessary, won't that give me an infection?
The ideal way to use a pessary is to insert it each day as part of your morning routine, and take it out for cleaning each night.
When this is not possible, women come to the clinic about four to six times a year for an exam and pessary cleaning.
Even when a pessary is worn almost continuously, vaginal infections are rare.
What will happen if I just ignore this problem? Will it get worse?
Probably. It may not happen quickly, but if left untreated, pelvic organ prolapse usually gets worse. However, treatment of prolapse should be based on your symptoms. In rare cases, severe prolapse can cause urinary retention that progresses to kidney damage or infection. When this occurs, prolapse treatment is considered necessary. In most other cases, patients should be the ones to decide when to have their prolapse treated - based on the symptoms they are having.
If I decide to have surgery, what can I expect during the recovery period?
Depending on the extent of your surgery, the hospital stay usually lasts one to four days. Many women have difficulty urinating immediately after the surgery and have to go home with a catheter in place to drain the bladder. These catheters are usually only necessary for 3 - 7 days.
Most patients require at least some prescription strength pain medicine for about one to two weeks after surgery.
Following any of our surgeries to correct urinary incontinence or prolapse, we ask that patients take it easy for 12 weeks to allow proper healing.
If my surgery is successful, how long will it last?
The goal of continence or pelvic reconstructive surgery is to recreate normal anatomy permanently. However, none of these procedures are successful 100% of the time. According to the medical literature, failures occur in approximately 5 - 15% of women who have prolapse surgery. In these cases, it is usually a partial failure requiring no treatment, pessary use, or surgery that is much less extensive than the original surgery.
Patients who follow our recommended restrictions for 12 weeks after surgery give themselves the best chance for permanent success.
I have prolapse, but I don't leak urine. Do I still need bladder testing?
Yes, if you are going to have surgery to correct the prolapse, bladder testing (called urodynamics) must be done first. That's because the prolapsed portion of your vagina may be pushing on your urethra and preventing urine leakage. If that is the case, having the prolapse corrected can give you a new problem - urinary incontinence. The only way to tell whether a continence procedure is needed at the time of prolapse surgery is to perform urodynamics while holding the prolapse up in its normal position.
How will my prolapse treatment affect my sex life?
If you choose to use a pessary, your sex life shouldn't change, except for the fact that the pessary usually needs to be removed prior to intercourse. If you have reconstructive surgery to correct prolapse, we recommend that you refrain from intercourse for three months after your operation to allow proper healing. After waiting three months, getting used to having intercourse will take some time, but most patients report an improved sex life afterwards.
When prolapse is severe, one surgical option is to completely close the vagina. This procedure (called colpocleisis or colpectomy) is less invasive than reconstructive surgery, which makes it especially useful for patients with severe medical conditions. Of course, intercourse is impossible after having this procedure, so it is only appropriate for patients who are ABSOLUTELY sure that they never want to be sexually active again.