What is pelvic prolapse?

When tissue protrudes out of the vaginal opening we call it prolapse. Common terms include:

• Cystocele: When the front wall of the vagina prolapses.
• Rectocele: When the back wall of the vagina prolapses.
• Apical: When the top part of the vagina prolapses.

What causes pelvic prolapse?

As the baby delivers vaginally the pelvic floor tissues are torn. When the tissues do not completely heal there is a gap in the pelvic supports. This is similar to a hernia. Over time the tissue stretches and protrudes. Women with chronic constipation, smoking women and those with obesity issues are at more risk of developing prolapse. Prolapse is more common after three vaginal deliveries.

What are the symptoms of pelvic prolapse?

Prolapse symptoms include seeing or feeling tissue protruding from the vagina. Pelvic pressure, as if things are falling out, is sometimes reported. Some women find they must push against the back wall of the vagina to pass stool. Urinary incontinence is often part of the prolapse problem.

How is pelvic prolapse diagnosed?

A physical exam, during which you push like trying to deliver a baby or pass stool is used to diagnose and stage prolapse. Four compartments are evaluated, the vaginal opening(genital hiatus), the front wall (cystocele), the back wall(rectocele) and the apex(uterus or top of the vagina). There are four stages of prolapse and each compartment is given a stage.

• Stage I: The tissue descends but does not go to the vaginal opening.
• Stage II: The tissue descends to the vaginal opening.
• Stage III: The tissue descends beyond the opening.
• Stage IV: All tissues, including the apex or uterus, are beyond the vaginal opening. This is also called procedentia.

How many women have pelvic prolapse?

Approximately 10-15% of women will have a prolapse surgery in their lifetime. As women choose to have smaller families prolapse issues will decline.

What is the best treatment option for pelvic prolapse?

Following the examination, we will sit down and discuss options. Mild prolapse with minimal symptoms does not require surgery. Educating our patients that sex will not worsen the prolapse can relieve anxiety. Counseling on lifestyle changes such as not lifting heavy objects and correcting constipation issues can keep it from getting worse.

Higher stage prolapse does not require surgery unless you find it bothersome. A pessary is a non-surgical device for treating prolapse. It is generally used in elderly women who would be at risk for significant complications. Pessaries can be used by younger women. However, there is frequently discharge and most younger women opt for surgery. 

When surgery is the choice we will describe the repair for each compartment. We will help you find the right doctor for the least invasive, least painful prolapse procedure.