Patient Education
Pelvic Organ Prolapse
About Pelvic Organ Prolapse
Things such as vaginal childbirth, hysterectomy, obesity, and aging can predispose a women to vaginal herniation known as pelvic organ prolapse. The bladder, rectum, uterus, and bowel may begin to bulge into or beyond the vagina. The different types of pelvic organ prolapse are named for the area of vaginal herniation or the organ which is herniating into the vagina. Prolapse may be associated with different levels of discomfort, sexual dissatisfaction, and bladder and or bowel problems. However, even severe degrees of pelvic organ prolapse are often asymptomatic. There are numerous ways to treat pelvic organ prolapse. Even though these are elective treatments, most are covered by health insurance.
Pelvic organ prolapse is a group of disorders encompassing the hernias of the female pelvic organs. General gynecologists and urologists often refer to these disorders as cystoceles, rectoceles, vaginal prolapse, enteroceles, and uterine prolapse. A hernia is a protrusion of a tissue through a wall of a body cavity in which it is normally contained. The organs of the pelvis are supported by a group of strong fibers made up of collagen and muscle. These tissues referred to as fascia, ligaments, and the levator muscles surround the vagina and reach out to the bony walls of the pelvis. They keep the vagina in its normal anatomical position and prevent the bladder, intestines, and rectum from herniation. When there is injury to or weakness of these supporting structures, pelvic organ prolapse can occur. The type of prolapse, or failure, is defined by the area of herniation
Anterior Compartment Failure (Cystoceles):
The anterior wall of the vagina normally supports the bladder. When a woman is lying on her back, the bladder's normal position is between the vagina and muscles of the lower abdomen. When herniation occurs, the bladder may protrude into or beyond the vagina. This is called anterior compartment failure or cystocele. When the prolapse is beyond the opening of the vagina, the anterior wall of the vagina bulges out. This may appear as a small golf ball sized bulge but can be larger than a softball. View Diagram Gallery
Posterior Compartment Failure (Rectoceles):
The posterior wall of the vagina normally provides support to the rectum. When a woman is lying on her back in bed, the rectum's normal position is underneath the vagina, toward the bed. When herniation occurs the rectum may protrude up into or beyond the vagina.
This is called posterior compartment failure or rectocele. When the prolapse is beyond the opening of the vagina, the posterior wall of the vagina bulges out.
This may appear as a small golf ball sized bulge but can be larger than a softball. View Diagram Gallery
Uterine Prolapse (Procidentia):
The uterus normally sits at the apex or top of the vagina. The bottom or opening of the uterus is called the cervix. The cervix protrudes into the top of the vagina, between the anterior and posterior walls.
When herniation occurs, the cervix and uterus may protrude into or beyond the vagina. This is called uterine prolapse or procidentia. When the prolapse is beyond the opening of the vagina, the cervix and apex of the vagina bulges out.
This may appear as a small donut shaped bulge but can also take on the shape of a small football. View Diagram Gallery
Apical Failure:
When the apex or top of the vagina herniates, uterine prolapse occurs. When herniation of the apex of the vagina occurs in a women who has had a hysterectomy, it is referred to as Apical Failure or Vaginal Vault Prolapse. When the prolapse is beyond the opening of the vagina, the apex of the vagina bulges out. This may appear as a small golf ball sized bulge but can be much larger than a softball. This bulge often contains intestine which normally are retained above the vagina. The bulge of intestines into or beyond the vagina occurs with apical failure and is referred to as an enterocele. View Diagram Gallery
Risk Factors:
Anything that damages or weakens the supporting structures of the pelvis will predispose to pelvic organ prolapse. The preponderance of data suggests that vaginal childbirth and hysterectomy are the greatest insults to the pelvic support system. Other risk factors may include obesity, aging, and hypoestrogenism (lack of estrogen).
