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Pelvic Organ Prolapse

An intricate network of muscles, ligaments and connective tissues supports and holds the pelvic organs in their normal position. As a woman ages, the muscles and tissues naturally begin to stretch. Weakening or collapse of this support network leads to prolapse of the pelvic organs – bladder, small intestine, uterus and rectum. In pelvic organ prolapse, the vagina and the organs surrounding and supporting it descend or fall from their normal positions. Without medical treatment or surgery, these structures may eventually prolapse farther into the vagina or even through the vaginal opening.

Pelvic organ prolapse is a common condition affecting many adult women. About 200,000 inpatient procedures are performed annually in the United States. Childbirth may lead to weakening of the pelvic support. Pregnancy itself, without vaginal birth has also been cited for weakening the support structures. Heavy lifting, straining from coughing, obesity, menopause, declining levels of estrogen and collagen, and prior pelvic surgery, such as a hysterectomy, can also be associated with pelvic organ prolapse.

Types of Pelvic Organ Prolapse

Pelvic organ prolapse is often used as a general term to encompass more specific organ prolapse dysfunctions:

  • Cystocele – Bladder descends into the anterior (front) wall of the vagina
  • Enterocele – Small intestine descends into the vaginal canal through the upper posterior (back) wall of the vagina, also known as a herniated small bowel
  • Rectocele – Rectum descends into the lower posterior (back) wall of the vagina
  • Uterine Prolapse – Uterus descends into the vagina, also known as a pelvic floor hernia
  • Vaginal Vault Prolapse – Top of vaginal wall descends into the vagina
  • Urethrocele – Urethra descends into the vaginal canal through the lower anterior vaginal wall
  • Perineocele – Perineum (area between rectum and vagina decends into the vagina

A combination of pelvic organ prolapse disorders is common. There are four grades of prolapse, as defined by the Pelvic Organ Prolapse Quantification (POP-Q) system created in 2002 by the International Continence Society.

Grade 1: Descent is greater than 1 centimeter from the vaginal entrance
Grade 2: Descent to within 1 centimeter of the vaginal entrance
Grade 3: Descent of more than 1 centimeter outside the vaginal entrance
Grade 4: Descent of prolapse totally outside the vagina

The severity of the condition is based on the degree of the descent.

Pelvic Organ Prolapse Symptoms

  • Discomfort or pressure in the vagina
  • Lump or bulge at the vaginal opening
  • Urinary and/or bowel incontinence
  • Incomplete voiding of bladder
  • Sexual dysfunction or painful intercourse
  • Frequent urinary tract infections (UTIs)
  • Pain in pelvis, lower abdomen, groin or lower back
  • Vaginal bleeding or excess discharge

Pelvic Organ Prolapse Testing

  • Pelvic exam
  • Urodynamics
  • Cytoscopy
  • Ultrasound

Pelvic Organ Prolapse Treatment

  • Lifestyle changes such as weight loss
  • Kegel exercises and pelvic floor muscle rehabilitation
  • Pessary placement
  • Pelvic organ prolapse surgery (sacrocolpopexy)
  • Robotic laparoscopic surgery
  • Hysterectomy

Pelvic Organ Prolapse Surgery

More than 120,000 cases of uterine and vaginal vault prolapse are surgically treated each year in the United States. Reparative prolapse surgery may be performed with or without synthetic mesh implant to repair the pelvic floor. For those patients requiring surgery, it is usually performed under general or local anesthesia. Robotic laparoscopic surgeries are minimally invasive alternatives to the traditional (open) gynecological surgeries.


Medical Disclaimer: The information provided in the Bladder Health Program of South Florida website should be used solely for educational purposes. It is not intended to replace the independent judgment of a healthcare provider. The appropriateness of a course of treatment for a patient may vary from the medical information provided herein due to individual conditions and/or complications. Always ask your physician about all treatment options, as well as the risks and benefits.

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