What is pelvic organ prolapse?

Pelvic organ prolapse is the name given to the condition in which the vagina and the surrounding organs lose their support and fall from their normal positions. For many women, prolapse can include descent of the uterus, vagina, bladder and/or rectum resulting in a "bulging" sensation within the vagina. In some cases, protrusion (obvious bulging) of these organs can occur. Pelvic organ prolapse can result in symptoms including urinary leakage, constipation, and difficulty with intercourse.

Laparoscopic colpopexy is a minimally invasive surgical technique that provides a safe and durable method for reconstruction of the pelvic floor and its contents without the need for a large abdominal incision. The goal of laparoscopic colpopexy is to re-suspend the vagina and pelvic organs through the key-hole incisions. In certain circumstances, a simultaneous hysterectomy, bladder suspension, or rectocele (rectum) repair may be required, all of which can be accomplished through a vaginal approach.

Pelvic organ prolapse (POP) is the condition in which any organs in the pelvis/vagina are "falling". When a patient has bladder prolapse, uterine, or vaginal prolapse, or rectal prolapse it can be considered POP. The downward descent of the pelvic or vaginal organs can cause a significant amount of problems with pelvic pressure, pelvic pain, problems with bladder or bowel emptying, pain with intercourse, and a noted bulging or protrusion of the organs into the vagina. The most common cause of pelvic organ prolapse (POP) is child birth. The delivery of a baby through the vagina can cause tearing of the connective tissue surrounding the pelvic organs which would subsequently cause a hernia of the bladder, the bowels, or the rectum into the vagina. These hernias and/or tears in the connective tissue is what causes pelvic organ prolapse. Other causes of pelvic organ prolapse (POP) are obesity, chronic straining, weak connective tissue disorders, smoking, or some types of vaginal or gynecologic surgeries. A hysterectomy can increase a patient's risk of pelvic organ prolapse (POP) because the connective tissue is disrupted at the apex of the vagina and if not properly repaired or reapproximated then there can be a weakness of the apex of the vagina causing future pelvic organ prolapse (POP).

Pelvic organ prolapse (POP) may cause the vagina, uterus, urethra, small intestine, and rectum to drop below their normal position, possibly causing stress incontinence. The prolapsed organs are covered with vaginal skin, so they just look like big bulges in any of the five areas mentioned below. If you have POP, you may feel as though you are “sitting on an egg.”

There are five main areas/types of prolapse, and you may have one or a combination of them:

• Cystocele - The bladder drops down into the vagina, resulting in
  incomplete emptying of the bladder and a possible urinary tract
  infection. A cystocele may become worse with time.

• Cystourethrocele - The lower part of the urethra drops down into the
  vagina. This is also usually associated with a cystocoele.

• Uterine prolapse - The uterus and cervix drop down into the vagina,
  resulting in urinary urgency and frequency. If you have had a
  hysterectomy, your vagina may prolapse, since it is located in the mid
  compartment of your pelvic area above the (now removed) uterus.

• Enterocele - The small intestine drops from the vagina.

• Retrocele - The rectum protrudes into the vagina, resulting in
  incomplete rectal emptying.

There are four different grades of pelvic organ prolapse, depending upon its severity:

Grade 1: The sagging organ bulges toward the opening of the vagina.

Grade 2: The sagging organ is halfway down the vaginal canal.

Grade 3: The sagging organ is at the opening of the vagina.

Grade 4: The sagging organ drops out of the vagina.

• Pelvic pressure and pain, leg fatigue and lower back pain
• Urinary problems, such as urinary incontinence or difficulty in starting to urinate
• Bowel problems, such as fecal incontinence or trapped stool, which can cause pain and constipation
• Painful intercourse