Pelvic Organ Prolapse

Pelvic organ prolapse is the gradual moving or “dropping” of a pelvic organ to a lower position in the pelvis. The top of the vagina, the bladder, or the rectum may be the main prolapsed organ. If the uterus has not been removed, it too can prolapse. 

Advanced Treatments and Cutting-Edge Research

Pelvic organ prolapse occurs when weakness in the vaginal wall allows organs such as the bladder, uterus, or rectum to bulge into the vaginal canal.

Sometimes, this is caused by weak supporting pelvic tissues and muscles. Childbirth, chronic cough, age, and constipation can lead to this pelvic muscle weakness. Prolapse also may occur more commonly within specific families or certain ethnic groups.

UT Southwestern’s team of specialists is at the forefront of pelvic floor dysfunction treatment, including pelvic organ prolapse, and we’re using advanced treatments to give women effective, longer-lasting results.

Symptoms of Pelvic Organ Prolapse

Pelvic organ prolapse usually does not appear quickly. Over time, patients may experience:

•  Heaviness, bulging pressure, and pain in the pelvic area
• Lower back pain
• Loss of bladder or rectal control
• Difficulty emptying the bladder or bowels
• In severe cases, the vagina or uterine cervix can be felt or seen as a bulge outside the body.

Diagnosing Pelvic Organ Prolapse

To diagnose pelvic organ prolapse, our doctors will perform a comprehensive diagnostic evaluation that includes a history, a physical examination, and a thorough discussion of symptoms. A careful pelvic exam should reveal which organs have dropped. If needed, specialized imaging can be performed to clarify the nature of the prolapse.

Treating Pelvic Organ Prolapse

Depending on the severity of symptoms, patients may or may not want to treat pelvic organ prolapse. However, the condition typically worsens when left untreated. 

In rare cases, severe prolapse can cause urine to be retained in the bladder and the kidneys, leading to kidney damage or infection. In this situation, treatment is necessary.

The goal of treatment is to recreate normal anatomy. However, treatment does not have a 100 percent success rate. According to the National Center for Biotechnology, common surgical repairs are ineffective for nearly 20 percent of patients.

Traditional repairs correcting pelvic organ prolapse often weaken over time and have required revisional surgery. Promising initial data from a pilot study at UT Southwestern, led by David Rahn, M.D., suggests that the simple addition of vaginal estrogen before and after certain prolapse repair surgeries might reduce the need for additional procedures in postmenopausal women.

Nonsurgical Treatment

We can use a pessary, or a supportive device, that is placed in the vagina to elevate it. Positioned similarly to a contraceptive diaphragm, the pessary uses the strength of the pelvic bones to support the vagina. Pessaries come in a variety of shapes and sizes and are most commonly made from either silicone or latex. Patients may continuously wear their pessary but should remove and clean it on a regular basis. Pessaries may be used as a temporary aid prior to surgery or as a permanent treatment for prolapse.

Surgical Treatment

We commonly use native tissue repair to surgically treat pelvic organ prolapse. In this surgery, we use the patient’s own body tissues to raise the prolapse organs and hold them in place. We can do this transvaginally, without external incisions.

After surgery, patients will sometimes be able to go home the same day, but most remain in the hospital for one to two days, depending on the extent of their surgery. Most patients require at least some prescription-strength pain medicine for one or two weeks after surgery.

Patients should avoid strenuous physical activity, especially lifting heavy objects, for 12 weeks to allow proper healing. Increased physical straining adds to the force against these weak pelvic muscles, possibly resulting in worsening prolapse or damage to a surgical repair.

Clinical Trials

An ongoing clinical trial at UT Southwestern is examining the effectiveness of vaginal estrogen – a supplemental, nonsurgical therapy – to reduce symptom recurrence and spare more women the risks and financial implications of revisional surgeries. Promising results from the pilot study led to UT Southwestern securing a grant from the National Institute on Aging for a new clinical trial, “Investigation to Minimize Prolapse Recurrence of the Vagina Using Estrogen (IMPROVE).” The goal of the trial is to determine whether vaginal estrogen also could help prevent recurrence of pelvic organ prolapse, thereby reducing the need for additional procedures.