Pelvic Organ Prolapse

By Anna R. McNanley, M.D.

Many women are familiar with the term “dropped bladder.”  While there is typically nothing wrong with the bladder itself, the muscles and connective tissues that support the “pelvic floor” become weakened over time, allowing the bladder and other organs to shift position and drop in the pelvis. Pelvic organ prolapse, a common condition in women, can affect quality of life.  It is estimated that up to 1/3 of women experience symptoms of pelvic organ prolapse.  Although the condition is common, many women who experience uncomfortable symptoms are not aware that there are effective treatments available.

Pelvic organ prolapse can be thought of as a type of “hernia through the vagina.”  Common symptoms include a bulge from the vaginal opening, pelvic or vaginal pressure and/or achiness, or a feeling of “sitting on something.”  There are many types and varieties of pelvic organ prolapse, ranging from a small “lump” at the vaginal opening to a grapefruit-sized bulge.  Symptoms tend to worsen as the day progresses, and can be relieved with lying down.  Many women are most comfortable just after waking up in the morning, before organs have “dropped.”

Other “pelvic floor” conditions associated with pelvic organ prolapse include: urinary incontinence, atrophy (thinning of the vaginal “skin”), urinary and fecal urgency, constipation, sexual dysfunction, and fecal incontinence.  While pelvic organ prolapse is not an emergency, it can affect bladder emptying, and at times can lead to urinary retention.  The condition is considered to be “multifactorial,” meaning it results from an interplay between multiple risk factors.  Established risk factors include:  a genetic predisposition, history of vaginal delivery, history of hysterectomy, aging, estrogen deficiency, chronic strain on the pelvic floor from conditions like obesity, chronic constipation, and repetitive heavy lifting, or chronic cough.

There are a variety of treatment options for pelvic organ prolapse, ranging from trying a pessary to having surgery.  Pessaries are objects that sit inside the vagina, like a diaphragm.  While they do not cure pelvic organ prolapse, they can be very effective in treating the symptoms, and are a good option for many women, particularly those who are experiencing bothersome symptoms but would like to avoid surgery.  Surgery can be performed through the vagina or the abdomen, and many women are candidates for minimally invasive surgery (vaginal surgery or laparoscopic, “keyhole surgery.”)  Laparoscopic surgery is often performed with the assistance the the Da Vinci robot, which utilizes technology to facilitate complex pelvic reconstructive surgeries.  Most surgeries are associated with a one or two-night hospital stay, and often times can be performed under local anesthesia.

Although often uncomfortable and at times associated with embarrassing conditions such as urinary or fecal incontinence, the good news is there are effective treatments available.  If you are experiencing symptoms of pelvic organ prolapse, contact the new Uro-Gynecology Center at APU for more information or to schedule an appointment.


*Dr. McNanley ran the UroGynecology Center at APU from 2009 – 2011.