What is pelvic organ prolapse?

In pelvic organ prolapse, there is a weakening of the support structures of the vagina. Organs that are supported by the vaginal structures—such as the bladder or uterus—then "fall" or protrude into the vaginal canal. (If it's the bladder, this is called a cystocele or anterior vaginal prolapse. If it's the uterus, this is called uterine prolapse.) The protruding organ is covered by vaginal tissue, so doctors can see a bulge but not the organ.

Women can have a combination of several organs being prolapsed, and the symptoms depend on the organ that is prolapsed and the degree of prolapse.

Pelvic organ prolapse (or prolapse or pelvic prolapse) is when the pelvic organs are no longer held in place by the pelvic floor muscles. This usually happens after years of activity, childbirth, and menopause. The organs begin to fall (or "prolapse") into the vagina.

Pelvic organ prolapse or vaginal prolapse occurs in women when the muscles and tissues that hold the pelvic organs in place begin to weaken. Subsequently, the uterus, bladder and rectum may press against the vaginal walls, causing them to protrude into the vagina. Treatment options depend on the type and degree of prolapse and include nonsurgical and surgical therapies. Some women have prolapse that does not cause them any symptoms and may not require treatment.

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As many as one-third of women at midlife have some kind of pelvic organ prolapse—a condition in which uterine, bladder, urethral, or rectal tissue protrudes into the vagina. It is one of the most common causes of incontinence.

The risk of pelvic organ prolapse increases with age, and it's more common in women who've given birth vaginally. Other contributing factors may include family history, excess weight, weak connective tissue, chronic constipation, and an occupation that requires heavy lifting.

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 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 occurs when the muscles that hold the pelvic organs (bladder, urethra, uterus, vagina, small bowel and rectum) get weak or stretched. This causes one or more of those organs to drop in the body. Some women will have pelvic organ prolapse and not notice it. For others it can be painful.