Prolapse

What is a prolapse?

Prolapse describes a condition where a pelvic organ drops (or prolapses) from its normal position and begins to press against the vaginal wall. Five primary types of prolapse can occur:

• cystocele, which occurs when the bladder descends toward the vagina and pushes against the vaginal wall
• rectocele, which occurs when the rectum prolapses into the vagina
• enterocele, which is caused by a prolapse of the small intestine through a herniation of the vaginal wall
• uterine, which is caused when the uterus descends into the vaginal space
• vaginal vault, which is after a woman has a hysterectomy and the upper portion of the vagina drops down into the lower portion of the vagina

In some cases, the prolapse may cause the vagina to protrude beyond the normal opening, causing considerable pain and chafing.

What causes prolapse?

Prolapse occurs when the muscles and ligaments that hold the pelvic organs in place become damaged or weak, allowing the organs to shift out of their normal positions. Several factors can cause or contribute to prolapse, including vaginal childbirth, hysterectomy or other surgeries, genetics, obesity, chronic constipation, smoking, steroid use or trauma. Prolapse is also more common among older women.

What are the symptoms of prolapse?

Prolapse symptoms can vary from one person to another based on the organ that has dropped, the overall health of the patient and other factors. Some common symptoms include:

• the presence of a bulge in the vagina, especially when the prolapsed organ is extending beyond the vaginal opening
• pelvic pressure
• back pain
• urinary incontinence
• painful intercourse
• constipation
• inability to empty the bladder
• increased urgency to urinate
• slow urine stream
• recurrent urinary tract infections

How is prolapse treated?

Prolapse that causes symptoms can be treated conservatively or with surgery. The plan is created after a thorough discussion between the patient and the physician to determine the patient’s goals and then the best treatment plan. Some prolapse can be treated minimally with physical therapy. More advanced prolapse requires intervention such as a pessary or surgery. Surgery is usually minimally invasive.