Understanding Prolapse

Pelvic organ prolapse is a weakness in the fibrous tissue (fasciae) that prevents bulging of our internal organs. It is essentially a vaginal hernia. For the most part, pelvic organ prolapse is not dangerous, but it can have a significant impact on a woman’s quality of life. 

How is prolapse similar to a hernia? If you first think of the abdomen, we have muscles and connective tissue (called fasciae) that make up a "girdle" to keep our small and large intestines in place. When there is a weakness in the abdominal wall, bulging of our intestines can occur. Other than when the intestines become incarcerated (stuck), the intestines are not affected by a hernia, it is essentially a weakness in the abdominal wall. Treatments for abdominal hernias focus on repairing the integrity and support of the muscle and fasciae (girdle) of the abdominal wall. Similarly, pelvic organ prolapse can occur when there is a weakness in the connective tissue of the vaginal walls and those tissues supporting the uterus.

Types of Prolapse

There are different types of prolapse and they can occur singly, or together.

A weakness of the anterior vagina is often called a cystocele. A weakness of the posterior vagina is known as a rectocele. When the uterus loses support, we refer to that as uterine prolapse. After hysterectomy, the top of the vagina can lose support, referred to as apical prolapse.

A Common Condition

Prolapse is common with estimates of prolapse identifiable in 19-34% of women during gynecologic examination. The risk factors for pelvic organ prolapse include genetic factors, childbirth, hormonal (menopause), tobacco use, or anything that leads to chronic increases in intra-abdominal pressure that is transmitted to the pelvis (obesity, heavy lifting, constipation).

Stages of Prolapse

Prolapse is staged with stage 0 (no prolapse) to stage 4 (advanced prolapse). Most women will have minimal or no prolapse symptoms until the prolapse advances to stage 3 or greater. The types of symptoms women may experience include:

• A feeling of a lump, a bulge or a heavy sensation in the vagina.
• Lower back pain that eases when you lie down.
• Pelvic pain or pressure.
• Decreased sensation during intercourse.

Available Treatments

There are surgical and non-surgical treatments available for pelvic organ prolapse. In terms of surgical treatments, minimally invasive approaches are available and afford patients less post-operative pain, less blood loss and fewer transfusions, less risk of infection, less scarring and improved cosmesis with smaller incisions, shorter hospital stays and faster recovery time.

The decision regarding the best treatment for prolapse involves a number of factors including general medical health, activity level, sexual activity and age. Our goal is to optimize a woman’s quality of life and to get you back to doing the things you enjoy doing as safely and quickly as possible.