Author: Vatche Minassian, MD, MPH, Chief of the Division of Urogynecology at Brigham and Women’s Hospital and Associate Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.

“I have constant low back pain.” “It feels as if I’m sitting on a ball.” “I have difficulty going to the bathroom.” This is how my patients with pelvic organ prolapse describe their condition. Like other urogynecologic conditions I treat, pelvic organ prolapse is more common than most women believe. One study found that a woman’s lifetime risk of having surgery for pelvic organ prolapse was 11 percent.

What is the Pelvic Floor?

Pelvic organ prolapse develops due to weakening of the connective tissue, muscles, and nerves that form the “pelvic floor.” The pelvic floor holds many of your internal organs in place, such as the intestines, bladder, and uterus. The pelvic floor must be strong enough to support these organs and flexible enough for women to give birth and maintain normal bodily functions such as urination and bowel movements.

Uterine prolapse, cystocele, rectocele, and enterocele each refer to specific areas that become weakened in pelvic organ prolapse. When the pelvic floor is weakened, the bladder, uterus, rectum, or small intestine can descend, creating a bulge in the vagina and resulting in the condition known as pelvic organ prolapse. Vaginal childbirth is the most common risk factor for developing pelvic organ prolapse, but women who have never been pregnant can still develop the condition. You can even develop pelvic organ prolapse after a hysterectomy.

Symptoms such as urinary incontinence, difficulty emptying the bladder, and a sensation of pressure in the vagina can occur with prolapse. Pelvic organ prolapse can also make it difficult for women to have bowel movements as pelvic muscles become weakened. Though pelvic organ prolapse rarely causes an immediate threat to your health, it can cause discomfort and interfere with your ability to do many things, including sexual activity.

How a Urogynecologist Can Help

At Brigham and Women’s Urogynecology Group, we find that women are reluctant to seek help for problems related to pelvic organ prolapse. Often women and their doctors assume that surgery is the only treatment. They may also have concerns about the safety and effectiveness of the surgery. Some women do not seek help because they do not understand what is happening to them, especially since symptoms develop gradually over months or years. Women may also be embarrassed to talk about health concerns related to a sensitive area of their bodies.

As urogynecologists, we have experience dealing with these especially sensitive health issues. We can help our patients evaluate both non-surgical and surgical treatment options. Non-surgical options include the use of pelvic support devices like pessaries and exercises such as Kegels. If surgery is recommended, a urogynecologist can help you understand what’s involved. Surgery for pelvic organ prolapse can be performed either vaginally or through a small incision in the abdomen using an instrument called a laparoscope. Even women who are in their 80s and 90s can get help. Complete recovery can take anywhere from four weeks to three months, and you will need to limit heavy physical activities for four or more weeks. Just as with a knee replacement or back surgery, you will need to protect your surgical repairs while you are healing.

If you think you may be suffering from pelvic organ prolapse, there is no reason to be embarrassed or isolated. A urogynecologist can provide guidance on treatment and help restore your quality of life.

Learn more about common urogynecologic conditions:

 

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