The Female Pelvic Medicine

Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP) occurs when the muscles and tissues of the pelvic floor become weak and no longer provide support to the pelvic organs. This results in their downward fall into the vagina. You may feel or see the tissue coming out of the vagina.

Common symptoms of POP

    • Pressure or a bulge near the vaginal opening
    • Difficulty using a tampon
    • Trouble with urination or bowel movements from the bulge
    • Vaginal irritation/chafing

Causes of POP

    • Pregnancy and Childbirth can damage the pelvic muscles and nerves. Over time this can result in dropping of the pelvic organs. 1 in 3 women who have given birth have prolapse. It is more likely if you deliver a large baby, have multiple babies or had a forceps delivery.
    • Aging and Menopause. Loss of estrogen with menopause and loss of muscle strength with age can weaken pelvic floor support.
    • Health issues that cause repeated straining such as a chronic cough or constipation.
    • Obesity
    • Heavy Lifting on a repeated basis such as extreme weight lifting
    • Genetics predisposition to weaker connective tissue.

Diagnosis of POP

Your urogynecologist can evaluate you for POP and the degree with a medical history and a pelvic exam. A standardized grading system is used to determine the severity.


    • Behavior/Lifestyle Changes can help prevent prolapse from worsening. Eliminating or minimizing some of the causes of POP such as weight loss, reducing constipation, quitting smoking can help.
    • Watchful Waiting: POP is not dangerous to your health. If you are not uncomfortable POP can be monitored over time.
    • Exercises: Pelvic floor exercises (Kegels) strengthen the muscles and can help mild POP symptoms.
    • Vaginal Pessary: A pessary is a silicone device that is inserted into the vagina, similar to a diaphragm. It lifts the bladder or vaginal walls to prevent the bulge from coming down.

Prolapse Surgery

Apical Suspensions: these procedures restore the support of the top of the vagina.

    • Sacral Colpopexy is performed through an abdominal incision, laparoscopically, or robotically. Mesh is attached from the vagina to strong ligaments on the sacrum.
    • Uteroscaral or Sacrospinous Ligament Suspension procedures are performed through the vagina with no abdominal incisions and no mesh. The top of the vagina is attached to a pelvic ligament.

Anterior Vaginal Prolapse Repair (anterior repair) uses an incision in the vaginal wall underneath the bladder to fix a cystocele (bladder drop). Sutures, mesh, or a graft are used.

Posterior Vaginal Prolapse Repair (posterior repair) uses an incision in the vaginal wall over the rectum to fix a rectocele (rectal bulge in the vagina). It rebuilds the wall between the vagina and rectum. A graft or mesh may be used.

Obliterative Procedure (Leforte Colpocleisis, Total Colpocleisis) shortens the vagina by stitching the inside vaginal walls together. This is a highly successful surgery for prolapse but means the patient can no longer have sexual intercourse.

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