The pelvis has three layers of support, including bone, muscle and connective tissue. They all work together to support the pelvic organs (uterus, vagina, bladder, bowel, rectum and anus). If the muscles and tissues supporting the pelvic organs weaken either through stretching or tearing, the pelvic organs can move out of their normal position, causing organs to drop or herniate into the vagina. This is known as pelvic organ prolapse. It is especially common for patients who have given birth and older patients. The good news is it is treatable.

Who is most likely to get pelvic organ prolapse?

Pelvic organ prolapse is a type of pelvic floor disorder. While it is less common than urinary or fecal incontinence, it still affects around 3% of U.S. women. Pelvic organ prolapse is more common in older patients who are Hispanic or white. Some common risk factors for pelvic organ prolapse include:

• Vaginal birth – Having vaginal childbirth can stretch the muscles that support the pelvic organs. The more vaginal childbirths a patient has, the higher the risk of developing pelvic organ prolapse later in life. Single childbirth is associated with an increased risk of uterine prolapse (a drop of the uterus), and every additional delivery up to five births increasing the risk of prolapse by 10%-20%. Pelvic organ prolapse is seen in 40%-60% of patients who have had children.
• Giving birth to a baby that weighs more than 8 ½ pounds
• Aging – Pelvic floor disorders, including pelvic organ prolapse, are more common in older patients. According to the Office of Women’s Health, about 37% of patients with a pelvic floor disorder are 60-79 years old, and half are 80 years or older.
• Family history
• Long-term pressure on the abdomen – This can include pressure from excess weight, frequently straining during bowel movements and chronic coughing.

What are the symptoms of pelvic organ prolapse?

Symptoms for pelvic organ prolapse can vary depending on how severe the case is. Some patients may not experience anything. Other patients may have some more noticeable symptoms, including:

• A bulge that appears to be coming out of the vagina – this can be seen or felt like a ball or egg sensation
• Pain or discomfort during intercourse—feels like the partner is bumping up against the prolapse
• Pressure or a feeling of fullness in the pelvis—which worsens during the day
• Urinary hesitancy (difficulty starting the stream) or stool trapping (feeling like the bowel movement comes down but won’t go out the anus). Some women learn to press on the prolapse in order to urinate or have a bowel movement and this is termed splinting

Patients may find that their symptoms become worse after standing for a long time or after physical activity, including exercise or sexual intercourse.

If you start to experience these symptoms, it is important you talk with your doctor, who can determine if you have pelvic organ prolapse through a pelvic exam. In some cases, other testing is ordered to better define urinary symptoms.

What are treatments for pelvic organ prolapse?

Treatment options for pelvic organ prolapse can vary based on severity and include non-surgical and surgical options.

For patients who do not have severe symptoms, they may benefit from non-surgical treatments, including:

1. Pelvic floor exercises – Often called Kegel exercises, pelvic floor exercises can strengthen your pelvic floor. Exercises include contracting and relaxing the muscles that surround the opening of the vagina, rectum and urethra.
2. Change in dietary habits – If you are experiencing bowel problems with pelvic organ prolapse, your doctor may recommend changes to your diet that include eating more food with fiber, helping with constipation.
3. Pessary device – this small device can be inserted into the vagina and helps support organs that have prolapsed.

If treatment beyond non-surgical options is called for, your doctor will first consider factors such as your age, sexual history, desire to have children and symptom severity. Depending on the answer to these questions and which organs have prolapsed, your doctor may suggest surgical treatment options. Ochsner’s pelvic health team offers pelvic reconstruction (with and without mesh) and offers procedures to help support the uterus or vagina. Surgery for pelvic organ prolapse can be done through your vagina or abdomen, and your doctor may use synthetic mesh to repair the prolapse through the abdomen. But mesh is no longer used to repair the prolapse through the vagina because of safety issues. It is important to keep in mind that surgery will only correct the tissues that create a bulge. If your symptoms are not severe and you have no discomfort, then surgery is not needed.

Can pelvic organ prolapse be prevented?

While we can’t always control some factors of pelvic organ prolapse, like family history or the decision to have a child, there are some steps you can take to reduce your chances of developing pelvic organ prolapse, including:

• Maintaining a healthy weight
• Eating foods high in fiber to help with bowel movements
• Practice pelvic floor exercises
• Avoid smoking as it can lead to chronic coughing and can also affect the body’s tissues.

The female pelvic health team at Ochsner is made up of experienced, board-certified physicians trained in female pelvic medicine and reconstructive surgery. We can evaluate and treat different types of pelvic organ prolapse.