Pelvic Organ Prolapse

Diagnosis

Diagnosis of pelvic organ prolapse starts with a medical history and a pelvic exam. This helps your healthcare professional determine the type of prolapse you may have.

Additional tests may include:

• Pelvic floor strength tests. During a pelvic exam, the provider evaluates the strength of the pelvic floor and sphincter muscles, which support the vaginal walls, uterus, rectum, urethra, and bladder.
• Bladder function tests. These tests can assess whether the bladder leaks during the exam or how well the bladder empties.
• Imaging. MRI or ultrasound may be recommended for complex cases of pelvic organ prolapse.

Treatment

Treatment depends on the severity of symptoms and how much they affect quality of life. Mild prolapse that does not cause discomfort may not require treatment, while more bothersome prolapse may need medical or surgical intervention.

Medications
• Vaginal estrogen may help strengthen vaginal tissue and relieve dryness in postmenopausal individuals. Discuss with your healthcare professional whether this is appropriate.

Physical therapy
• Pelvic floor exercises with biofeedback can strengthen the muscles. Sensors placed in the vagina, rectum, or on the skin monitor muscle activity. A computer shows if you are contracting the right muscles and the strength of each contraction. Over time, stronger muscles may reduce symptoms.

Pessaries
• Pessaries are silicone devices inserted into the vagina to support pelvic organs. Some people can remove, clean, and replace them at home, while others may need follow-up visits every three months.

Surgery
Surgical options aim to correct the prolapse and relieve symptoms:

• Anterior prolapse. The bladder bulges into the front vaginal wall, called a cystocele. Repair involves an incision in the vaginal wall, lifting the bladder, and securing connective tissue. Additional procedures, like a bladder neck suspension or sling, may be done if urinary incontinence is present.
• Posterior prolapse. The rectum bulges into the back vaginal wall, called a rectocele. Surgery secures the connective tissue between the vagina and rectum and removes excess tissue.
• Uterine prolapse. If future pregnancies are not planned, a hysterectomy may be performed to remove the uterus.
• Vaginal vault prolapse. After a hysterectomy, the top of the vagina can lose support and drop, sometimes involving the bladder, rectum, or small bowel (enterocele). Surgery may be done vaginally or abdominally (laparoscopic, robotic, or open), sometimes with mesh to support tissues.

Surgery corrects the tissue bulge but does not restore weakened tissues, so prolapse may recur. Surgery is not needed if the bulge does not cause symptoms.