Pelvic organ prolapse (POP) is a condition in which your pelvic floor (the muscles, ligaments and tissues that support your pelvic organs) become too weak to hold your organs in place. Your pelvic floor muscles act like a powerful sling that supports organs like your vagina, uterus, bladder and rectum. If these muscles become too loose or sustain damage, the organs they support shift out of place. If the ligaments or connective tissue that hold the organs in place are stretched or torn that will also cause the organs to drop.
With mild cases of POP, your organs may drop. In more severe cases, they may extend outside your vagina and cause a bulge.
Pelvic organ prolapse is one type of pelvic floor disorder, along with urinary and fecal incontinence. Commonly these other disorders occur together with POP.
The type of prolapse you have depends on where the weaknesses are in your pelvic floor and what organs are affected.
Anterior vaginal wall prolapse (dropped bladder): Weakened pelvic floor muscles above your vagina can cause your bladder to slip out of place and bulge onto your vagina. This type of prolapse is also called cystocele. Anterior vaginal wall prolapse is the most common type of POP.
Urethrocele: Weakened pelvic floor muscles can cause the tube that carries pee from your bladder to outside your body (urethra) to droop. A dropped urethra often accompanies a dropped bladder.
Posterior vaginal wall prolapse (dropped rectum): Weakened pelvic floor muscles in between your vagina and rectum can cause your rectum to bulge onto the back wall of your vagina. This type of prolapse is also called a rectocele.
Enterocele: Weakened muscles in your pelvis can cause your small intestine to bulge onto the back wall or the top of your vagina.
Uterine prolapse (dropped uterus): A weakened pelvic floor can cause your uterus to drop down into your vaginal canal.
Vaginal vault prolapse: Weakened pelvic floor muscles can cause the top part of your vagina (vaginal vault) to drop into your vaginal canal.
People of all sexes can experience POP, but you’re at much greater risk if you’re a woman.
Up to 50% of women will develop at least a stage 2 POP over the course of their lives. The most common time to develop symptoms is after menopause but it can occur at any point in life, particularly after having children.
The most common symptom is feeling a bulge in your vagina, as if something were falling out of it. Other symptoms include:
Your pelvic floor can weaken for many reasons. A weak pelvic floor increases your likelihood of a prolapse.
Vaginal childbirth is the most common factor associated with developing POP. Multiple vaginal deliveries, difficult deliveries, having twins or triplets, or carrying a larger than average fetus (fetal macrosomia) all increase the odds that your pelvic floor muscles will sustain injuries that may lead to POP.
The aging process can cause your muscles to lose strength, including your pelvic floor muscles. One factor is declining estrogen. During menopause, your body produces less estrogen. The decline can cause the connective tissues that support your pelvic floor to weaken.
Having a heavier body increases your risk for POP. Studies have shown that people who are clinically overweight or have obesity are more likely to develop POP than people who are in the normal weight range.
Long-term pressure in your abdominal cavity can overwork your pelvic floor muscles, causing them to weaken. Chronic constipation, chronic coughing and frequent heavy lifting all increase your chance of developing POP.
A family history of POP may increase your odds of developing POP. Research into the genetic components of POP is ongoing, but it’s possible that you inherited a weaker pelvic floor.
Collagen irregularities can weaken the connective tissues in your pelvic floor, increasing the likelihood you’ll develop POP. People with connective tissue disorders, like Ehlers-Danlos Syndrome, and who have more movement in their joints are at a greater risk for developing POP.
During your appointment, the IWI team will review your symptoms and perform a pelvic exam. During the exam, you may asked to cough or bear down so that they can see the full extent of your prolapse when you’re straining and when you’re relaxed. They may examine you while you’re lying down and while you’re standing. Often, a pelvic exam is all it takes to diagnose a prolapse.
Additional tests may include:
Bladder function tests that allow your provider to look for signs of urinary issues that are common with POP. Tests may include a cystoscopy, a procedure that allows us to see inside your bladder and urethra. You may also be asked to perform a urodynamics test to see how well your bladder and urethra are storing and releasing pee.
Imaging procedures that allow a view inside your pelvic cavity. We may order a pelvic floor ultrasound or MRI to determine the extent of your prolapse. Imaging isn’t often used except in complex cases.
The Pelvic Organ Prolapse Quantification (POP-Q) system classifies POP based on how mild or severe your prolapse is. The scale ranges from zero to four. Stage Zero means your organs haven’t shifted out of place at all. Stage Four means you have a complete prolapse. A complete prolapse is the most severe kind. It may involve an organ bulging out of your body. Both the type of prolapse and the extent of the prolapse will shape your treatment.
Dr. Guerette and the Intimate Wellness Institute team are the most experienced, specialized practice for the treatment of POP in the region. IWI offers the widest array of treatments available. Our goal at IWI is to obtain an accurate diagnosis and work with you to explain all options and understand your expectations and goals to select the best treatment for you.
Nonsurgical treatments include:
Vaginal pessary: A removable silicone device that your provider can insert into your vagina to hold a sagging organ in place.
Pelvic floor therapy and biofeedback: Strengthening exercises for your pelvic floor. Your IWI team may include a physical therapist to test the strength of individual muscles and teach you targeted exercises to train these muscles. These are the Kegel exercise muscles.
EmsellaTM Advanced Pelvic Floor Therapy: Emsella is a FDA-approved revolutionary treatment for incontinence. The BTL EMSELLA treatment uses High Intensity Focused ElectroMagnetic Energy (HIFEM) to stimulate and strengthen ALL the pelvic floor muscles, not just the subset that can be exercised with voluntary contractions (Kegel exercises). These stronger pelvic floor muscles restore continence and the confidence to enjoy normal daily activities without fear of losing bladder control. During each 28-minute session you sit comfortably on the Emsella chair while it generates thousands of supramaximal pelvic floor muscle contractions. Each session is equivalent to doing 11000 pelvic floor exercises but without the hard work! The procedure is non-invasive, and you remain fully clothed throughout. No drugs are required and the most you will feel is a slight tingling during the treatment. With no recovery time needed you can leave immediately after each session and resume normal daily activity. The majority of people need a course of six sessions over a period of three weeks to see optimum results, with most people seeing and feeling results after just two or three treatment sessions. Dr. Guerette and the IWI team have been pioneers in the development of Emsella for the treatment of female urinary incontinence. IWI had the second Emsella machine in North America and has the most experience with Emsella. Dr. Guerette has been the lead investigator on the studies to evaluate Emsella.
Laser and Radiofrequency (RF) Vaginal Tightening: Dr. Guerette is one on the pioneers in using gentle lasers and radiofrequency devices to tighten, restore and rejuvenate vaginal tissue to improve many issues including POP. IWI has the most comprehensive laser and RF options available for vaginal tightening. In appropriate candidates simple office treatments with no preparation or recovery can be used to tighten the vaginal tissue and reduce symptoms of POP.
Surgery may be an option if your symptoms haven’t improved with conservative treatments or if the extent of the issue cannot be satisfactorily corrected with non-surgical treatments.
Two types of surgeries are available: obliterative surgery and reconstructive surgery. Obliterative surgery sews your vaginal walls shut, preventing organs from slipping out. Reconstructive surgery repairs the weakened parts of your pelvic floor back to normal. The most common surgeries are listed below.
Colpocleisis is an obliterative procedure that results in a shortened and closed vagina. It prevents any organs from bulging outside your body. It’s a good option if you’re too frail and too sick for reconstructive surgery and don’t wish to have penetrative vaginal sex anymore.
Vaginal Reconstructive Surgery: Dr. Guerette is the most experienced and most advanced vaginal surgeon in the region and one of the most respected in the world. He has developed many of the advanced techniques currently being used. He has also developed specialized collagen grafts to avoid using mesh that have shown equal or better outcomes without the risk of mesh healing issues.
Anterior Repair: The Anterior Repair is the most commonly utilized operation for correction of a cystocele/bladder prolapse. Anterior repairs are used when the bladder wall of the vagina is broken or stretched in the midline. Most traditional techniques for anterior repair have high failure rates and poor functional outcomes. Dr. Guerette has developed advanced non-mesh techniques using collagen grafts to give more durable results with better bladder and sexual function. The Anterior Repair is performed through the vaginal opening.
Paravaginal Repair: A Paravaginal repair restores the attachment of the bladder to the side of the pelvis when it has been torn away. Dr. Guerette has developed a specialized technique using collagen grafts without mesh to correct this issue through a small vaginal incision under the bladder. This technique also corrects paravaginal defects and central cystoceles (above) at the same time.
Posterior Repair: The Posterior Repair is the most commonly performed operation to repair a rectocele and an enterocele. Dr. Guerette has developed a unique technique using collagen grafts (no mesh) to re-established the connective tissue between the vagina and bowel (enterocele repair) and repair the muscles between the vagina and the rectum (rectocele repair). The collagen grafts are uniquely designed to actually attach to ligaments in the pelvis to give a more durable repair with better bowel and sexual function.
Sacrospinous Fixation: This is a technique through a small vaginal incision to attach the top of the vagina and uterus to the sacrospinous ligaments to correct vaginal vault and/or uterine prolapse. Dr. Guerette has developed a unique, patented technique to correct these defects and restore normal anatomy using collagen grafts without mesh and using bilateral ligaments to maximize durability and function. Diagram
Sacrocolpopexy: This surgery is used when the vaginal vault or uterus and the bladder and rectum are all prolapsing (complete prolapse). The procedure uses a specially designed Y-mesh to restore the walls between the vagina and bladder, the vagina and the rectum, and bring the top of the vagina up to a ligament over the sacrum (tailbone). It often includes a hysterectomy if the uterus is still present. Dr. Guerette performs this procedure using the DaVinci Robot system. Dr. Guerette is the most experienced robotic female pelvic reconstructive surgeon in the region and has been performing these procedures since 2006 with over 3000 women treated and has served as director of the Robotics program at his medical center for many years. He has been involved in many critical studies for the technology and is the only surgeon in the region that is able to perform the procedure with a hysterectomy without enlarging the incisions. Dr. Guerette strongly believes all efforts should be made to keep these procedures as minimally invasive as possible.
Sacrohysteropexy treats uterine prolapse. Dr. Guerette attaches surgical mesh to your cervix and vagina and attaches it to your tailbone, lifting your uterus into place. Sacrohysteropexy is an option if you don’t want to have your uterus removed (a hysterectomy). Dr. Guerette and the IWI team are strong proponents for giving a women a choice to keep her uterus under the appropriate circumstances.
As POP, bladder and bowel problems often occur together Dr. Guerette will frequently perform multiple procedures at the same time.
Many causes of POP are out of your control. But you can put healthy habits into place to reduce your risk.
Do pelvic floor exercises daily. Having muscle control in your pelvic floor provides stronger support for your organs.
Maintain a healthy weight. Talk to us about what a healthy weight means for you.
Prevent constipation. Chronic constipation can strain your pelvic floor muscles. Choosing a high-fiber diet and drinking plenty of fluids can help prevent constipation.
Don’t smoke. Smoking can lead to chronic coughing, which can put undue pressure on your abdominal cavity and strain your pelvic floor muscles.
Protect your pelvic floor when you lift. Get help lifting heavy objects. When lifting alone, bend your hips and knees to squat while keeping your back as straight as possible. Don’t twist your torso while you’re lifting. Correctly positioning your body prevents injury to your low back and protects your pelvic floor, too.
Your prognosis depends on your prolapse (where it’s located, it’s severity) and your goals (to have children, to continue having penetrative sex, to have a less invasive surgery, etc.). Talk to the IWI team about how your prolapse shapes your treatment options. Discuss how the benefits of treatment will allow you to achieve your goals, and ask about any risks that may prevent you from achieving them. Grounding your expectations in honest conversations with us will improve your experience with POP.
Left untreated, your prolapse and your symptoms will worsen. If you are not ready for treatment the IWI team can monitor your prolapse and recommend treatments if it progresses to the point where it’s negatively impacting your quality of life.
Uterine Prolapse means the uterus lacks support because the original supporting ligaments known as the uterosacral ligaments have broken or stretched. When the ligaments weaken, the uterus prolapses along with the vaginal vault (aka apex). This is a common phenomenon among women of all ages but most commonly associated with women who have had childbirth.
Uterine Preservation: IWI and Dr. Guerette are strong advocates for giving women the choice to preserve their uterus to maintain child-bearing ability or if she simply does not wish to have a hysterectomy. IWI has the most comprehensive array of non-surgical options to minimize symptoms of uterine prolapse. Dr. Guerette has developed specialized techniques to re-suspend (not remove) the uterus to correct uterine prolapse. These techniques include patented vaginal surgery and minimally invasive robotic surgery. This allows women who are suffering from uterine prolapse to correct the problem prior to completing child-bearing and respects the emotional importance some women attach to maintaining their uterus. Dr. Guerette is the only surgeon in the region that specializes in uterine preservation.
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