The Institute for Women's Health

Pelvic organ prolapse is the descent and possible protrusion of the pelvic organs onto the vaginal walls that sometimes results in their protrusion through the vaginal opening. It results from the weakening, stretching and detachment of the muscles and ligaments of the pelvic floor that hold those pelvic organs (the vagina, the uterus, the bladder, the urethra, the rectum) in place.

Pelvic organ prolapse can receive different names depending on the part of the vagina that is most affected. Examples are: “prolapse,” “vaginal prolapse,” “vaginal vault prolapse,” “dropped vagina,” “uterine prolapse,” “dropped uterus,” “bladder prolapse,” “dropped bladder,” “cystocele,” “rectal prolapse,” “rectocele,” “dropped rectum,” “enterocel.” They are not necessarily synonyms (see Types of prolapse).

Symptoms vary. The most common one is a sensation of a bulge at or through the entry of the vagina. Some patients have described it as a “ball,” a “baby’s head,” “an egg,” or a “Roma tomato” coming out of the vagina. Other possible symptoms can include: vaginal pressure, lower back pain, vaginal pain, pain with sex, incomplete bladder emptying, urinary urgency and frequency, difficulty having a complete bowel movement, constipation.

There are surgical and non-surgical options for the treatment of prolapse.

Types of prolapse

It is common to have different types of prolapse at the same time and different types of prolapse may require different treatments. Most experts and research agree that addressing the apical vaginal prolapse is a key to increase the success in the treatment of any prolapse.

Apical vaginal prolapse

It is also called “uterine prolapse,” “vaginal vault prolapse” (if there is no uterus), “enterocele,” “dropped uterus” or “dropped vagina.”

It occurs when the ligaments supporting the top of the vagina weaken and stretch leading to the uterus or the top (or cuff) of the vagina “falling down” and sometimes out. On top of the symptoms of bulging, if the vagina or the cervix of the uterus is exposed in the “outside” they can develop ulcerations.

Anterior vaginal wall prolapse

It is also often “cystocele,” “urethrocele,” “cystourethrocele” or “dropped bladder.” It occurs when the ligaments supporting the anterior vagina and the base of the bladder weaken, leading to the bladder “falling down” onto the vagina. It can cause urinary symptoms such as incomplete bladder emptying, urinary frequency and urgency.

Posterior vaginal wall prolapse

It is also sometimes called “rectocele” or “enterocele.” It occurs when the tissue supporting the posterior vagina and part of the rectum weaken leading to the rectum “falling down” onto the vagina. It can cause defecatory symptoms such as constipation, having to strain to have a bowel movement or even the need to put a finger in the vagina or the rectum to facilitate emptying the bowels.

Rectal prolapse

It results from the failure of the tissue keeping the rectum in place leading to the protrusion of the rectum through the anus (not the vagina, that would be a posterior vaginal wall prolapse or “rectocele”).

Rectal prolapse, at the beginning, can be confused with a hemorrhoid. It is a red soft tissue with the shape of a donut. It can cause painful bowel movements, blood or mucus on the stool or underwear, loss of bowel control.

Treatment of Pelvic Organ Prolapse

While several things can be done to decrease the risk of prolapse from developing (See prevention of pelvic organ prolapse), there are currently to types of treatments for this condition:

  • Pessaries
  • Surgeries

Surgeries for Pelvic Organ Prolapse

In Pelvic Reconstructive Surgery there is no “one surgery fits all”. There are multiple surgeries that can be done to treat Pelvic Organ Prolapse. Some of them are done vaginally and some are done abdominally (when our doctors choose the latter, he does them laparoscopically, using a camera and instruments through a very small incisions). They can involve the use of synthetic or biologic grafts (“mesh”) or not. They can take a few minutes to several hours. The choice of the procedure will be based on the part of the vagina that is most affected by the prolapse, on how severe the prolapse is, what are the symptoms and a detailed discussion with our doctors about the advantages and disadvantages of each one of the procedures he can offer.

Types of surgery:

  • Sacrospinous ligament suspension
  • High uterosacral ligament suspension
  • Sacrocolpopexy
  • Anterior vaginal wall repair
  • Posterior vaginal wall repair