Pelvic organ prolapse is a medical condition that occurs when the normal support of the vagina is lost, resulting in “sagging” or dropping of the bladder, urethra, cervix and rectum. As the prolapse of the vagina and uterus progresses, women can feel bulging tissue protruding through the opening of the vagina.
Causes & Risk Factors
By studying large numbers of women with and without prolapse, researchers and urogynecologists have identified certain risk factors that predispose, cause, promote or worsen pelvic organ prolapse. The strength of our bones, muscles and connective tissue are influenced by our genes and our race. Some women are born with weaker tissues and are therefore at risk to develop prolapse. Caucasian women are more likely than African American women to develop pelvic organ prolapse. Loss of pelvic support can occur when any part of the pelvic floor is injured during vaginal delivery, surgery, pelvic radiation or back and pelvic fractures during falls or motor vehicle accidents. Hysterectomy and other procedures done to treat pelvic organ prolapse also are associated with future development of prolapse. Some other conditions that promote prolapse include: constipation and chronic straining, smoking, chronic coughing and heavy lifting. Obesity, like smoking, is one of the few modifiable risk factors. Women who are obese have a 40 to 75% increased risk of pelvic organ prolapse. Aging, menopause, debilitating nerve and muscle diseases contribute to the deterioration of pelvic floor strength and the development of prolapse.
Incidence
We do not know exactly how common pelvic organ prolapse is because research is limited to women who seek health care. It is estimated that nearly 50% of all women between the ages of 50 and 79 have some form of prolapse. The lifetime risk that a woman will have surgery for the correction of prolapse or urinary incontinence in the United States is about 11%. We also know that only one-third of these women will undergo repeat corrective surgery for these conditions. Approximately 200,000 procedures for correction of pelvic organ prolapse are performed each year in the United States. We believe that is just the tip of the iceberg as many women manage their prolapse without surgery.
Symptoms
Some loss of support is a very common finding upon physical exam in women, many of whom do not have bothersome symptoms. Those women who are uncomfortable often describe the very first signs as subtle-such as an inability to keep a tampon inside the vagina, dampness in underwear or discomfort due to dryness during intercourse.
As the prolapse gets worse, some women complain of:
- A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements
- The feeling that they are “sitting on a ball”
- Needing to push stool out of the rectum by placing their fingers into the vagina during bowel movement
- Difficulty starting to urinate, a weak or spraying stream of urine
- Urinary frequency or the sensation that they are not emptying their bladder well
- The need to lift up the bulging vagina or uterus to start urination
- Urine leakage with intercourse