Pelvic Organ Prolapse

In women, pelvic organ prolapse occurs when the muscles, ligaments and tissues that support the pelvic organs weaken, causing the organs to "slip out of place" or to sag. Without support, these organs, which include the uterus, bladder and rectum, may press down on and even bulge through the vagina.

Types of pelvic organ prolapse includes:

Uterine prolapse: protrusion of the uterus into or through the vagina
Vaginal prolapse: protrusion of the top of the vagina into or through the lower part of the vagina
Cystocele: protrusion of the bladder into the vagina
Rectocele: protrusion of the rectum into the vagina
Enterocele: protrusion of the small intestine into the vagina

Causes of Prolapse

Weak or damaged pelvic muscles and ligaments contribute to pelvic organ prolapse, with the most common causes being:

Advanced age
Vaginal childbirth
Pelvic surgeries
Menopause, which decreases a woman’s estrogen levels
Obesity

Symptoms of Pelvic Organ Prolapse

Pelvic organ prolapse often results in pressure and discomfort in the pelvic area, as well as vaginal pain in some women. Symptoms often include:

Feeling a heavy sensation in the vagina that worsens as the day progresses
Urinating frequently, having difficulty starting the urine stream, spraying of the urine stream and difficulty emptying the bladder completely
Urinary leakage during intercourse
Difficulty having bowel movements

If you are exhibiting symptoms of pelvic organ prolapse, the first step is to have a physical exam by a specialist who will also evaluate the strength of the pelvic floor muscles and look for bulging or other signs of vaginal prolapse during an internal exam. Your doctor may also order other tests such as:

A pelvic ultrasound
Urodynamic testing, which are diagnostic tests that evaluate the function of the bladder and urethra

At Holy Cross Health, our team of pelvic health specialists are experts in the diagnosis and treatment of pelvic organ prolapse, including a number of effective, innovative minimally invasive vaginal prolapse surgeries.

Treatments for Prolapse

The type of prolapse surgery your surgeon will recommend depends upon the type of pelvic organ prolapse, your symptoms, and other medical conditions you may have.

At Holy Cross Hospital in Silver Spring and Holy Cross Hospital in Germantown, many of these procedures are performed laparoscopically or robotically. Laparoscopic technique in which two or more small incisions are made through which surgeons pass a video camera and specialized instruments.

Our gynecologic surgeons are also leaders in robotic-assisted laparoscopy in which the surgeon controls a robotic system of surgical tools from outside the body. The technology allows the surgeon to use natural wrist movements and view the process on a screen that shows three-dimensional images.

Other procedures are performed transvaginally, in which surgeons thread instruments through the vagina and into the cervix.

Types of Prolapse Surgery

Most pelvic organ prolapse surgeries are reconstruction procedures that restore the pelvic organs to the original position. These surgeries may also prevent pelvic organ prolapse in the future and include:

Sacrocolpopexy surgery – In this type of procedure, small incisions are made instead of a larger incision used in open surgery. Cameras that provide a video image and instruments are passed through the small incisions. Sometimes robotic laparoscopic surgery is performed, in which the surgeon uses robotic tools to guide his hands, and views real-time three-dimensional images.
Vaginal repair of prolapse - In this procedure, surgeons strengthen the vaginal wall with stiches to keep the prolapsed organ in position. Surgeons use the patient's own tissue and attach it to a ligament to hold the organs in place.
Robotic Rectal Suspension (Rectopexy) and Robotic Ventral Mesh Rectopexy - Rectopexy is a surgical procedure to repair a rectal prolapse. For patients experiencing rectal prolapse (where the rectum falls through the anus), surgeons at Holy Cross Health use a robotic approach to this technique that returns the rectum to its normal position in the pelvis. The surgeon uses stitches to secure the rectum, and the procedure can be performed with or without the use of surgical mesh to help hold the rectum in place.

For more information about the Pelvic Floor Program at Holy Cross Health, please call 301-754-8800.