Problems with pelvic organs can be a sensitive issue to talk about, but you don’t have to go through it alone. At Penn Medicine, our doctors offer expert care with a compassionate touch.
Our experienced doctors are specialists in pelvic medicine and reconstructive surgery. We provide comprehensive care for people with all types of pelvic organ prolapse. We offer the most advanced treatment options available, and we can help you even if previous treatments haven’t worked.
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse happens when a pelvic organ drops from its usual position and bulges into the vagina or rectum. The condition develops as the pelvic floor weakens or becomes damaged and can no longer support the organs. Prolapse is more common in females, but it affects males, as well.
The pelvic organs include:
- Bladder
- Rectum
- Small and large intestines
- Uterus (in females)
- Vagina (in females)
The pelvic floor is a network of muscles, nerves and tissues that support those organs like a hammock.
Types of Pelvic Organ Prolapse
The types of prolapse depend on which pelvic organ has moved out of place. Types that affect females include:
- Cystocele: Also called anterior vaginal wall prolapse, cystocele is the most common type of pelvic organ prolapse. The front vaginal wall sags, allowing the bladder to drop into the vagina.
- Enterocele: Part of the small intestine presses into the vagina. This condition is also called small bowel prolapse.
- Rectocele: In posterior vaginal wall prolapse, the back vaginal wall sags. The rectum (lower end of the large intestine) presses into the vagina.
- Uterine prolapse: The uterus drops into the vagina.
- Vaginal vault prolapse: The top part of the vagina sags lower into the vagina.
Males who have pelvic organ prolapse typically have rectal prolapse. With rectal prolapse, part of the rectum (end of the large intestine) bulges into the anus (where stool exits the body).
Causes of Pelvic Organ Prolapse
Risk factors for pelvic organ prolapse can be anything that weakens the pelvic floor, such as:
- Vaginal childbirth, especially more than one
- Long-term pressure on your pelvic area such as from obesity, chronic coughing, constipation or tumors, such as uterine fibroids
- Menopause or increasing age
- Neuromuscular disorders, which affect the nerves that control muscle movement, such as multiple sclerosis
- Pelvic injury or surgery such as hysterectomy to remove the uterus
Symptoms of Pelvic Organ Prolapse
The signs and symptoms of pelvic organ prolapse include:
- Bulge of tissue from the vaginal opening that you can see or feel
- Pain or a feeling of stretching in your groin or lower back
- Pressure, fullness, discomfort or pain in the pelvic area, which can worsen during physical activity or sexual intercourse
- Urinary symptoms such as incontinence (urine leaks), increased frequency or urge to urinate (overactive bladder), or slow urine stream
- Bowel symptoms, such as difficulty with bowel movements or accidental bowel leakage
Diagnosing Pelvic Organ Prolapse
We understand that problems with your pelvic organs can be difficult to talk about, and we’re here to help. Our urogynecologists meet with you in a comfortable setting to ask you about symptoms and medical history.
Our thorough evaluation includes a physical exam and an internal pelvic exam to check your pelvic organs. We also do pelvic floor strength tests to determine how severe the prolapse is and help plan treatment options.
We can usually confirm a diagnosis with the evaluation results. If we need more information to determine the type of prolapse, you may need one or more tests, such as:
- Bladder function test: We may ask you to strain or cough so that we can see whether prolapse or urine leaks happen with certain movements.
- Cystoscopy: We use a thin, tube-shaped scope with a tiny camera inserted through the urethra to examine inside your bladder. Cystoscopy can show problems that might be contributing to prolapse.
- Pelvic imaging: CT, MRI and ultrasound can show details of your pelvic organs and pelvic floor muscles. We use these imaging tests to see details that help us confirm a diagnosis or rule out other conditions.
- Urodynamic testing: We check bladder capacity, urine flow, pressure inside the bladder and other functions to see whether prolapse may be causing incontinence.
Pelvic Organ Prolapse Treatment at Penn Medicine
At Penn, your treatment is completely customized for your needs. Your team of pelvic floor specialists may include:
- Colon and rectal surgeons: When prolapse affects the intestines or rectum, you may receive care from our colon and rectal surgeons. Our surgeons have completed subspecialty training in colon and rectal surgery, so you know you’re getting the best treatment. Meet our colon and rectal surgery team.
- Urogynecologists: Our urogynecologists aren’t OB-GYN generalists — they have years of focused experience treating women with all types of pelvic floor disorders. Meet our urogynecology team.
- Urologists: Our urologists have subspecialty expertise in conditions that affect the bladder, kidneys, pelvic area and male genitals. They’re skilled in the full range of pelvic floor treatments.
- Nurse practitioners: Our nurse practitioners provide nonsurgical care for pelvic floor disorders. They collaborate with your doctor and support you throughout your treatment.
You have many treatment options, depending on how much the symptoms are affecting you. We work closely with you to find treatments that suit your preferences and help you feel better. We begin with conservative, nonsurgical treatments whenever possible.
Nonsurgical treatments for pelvic organ prolapse
Nonsurgical care includes self-care techniques and devices to support pelvic organs. We work with you to find the right combination of therapies, which include:
- Pelvic floor exercises: Strengthening your pelvic floor muscles through physical therapy can help relieve symptoms. Our specialized pelvic floor physical therapists tailor a plan to your needs, showing you exercises that you can do at home. Learn more about pelvic floor outpatient physical rehabilitation at Penn Medicine.
- Healthy eating plan: Pressure from excess weight and straining during bowel movements can contribute to pelvic organ prolapse. Eating more fiber and other simple dietary changes can relieve constipation and help you maintain a healthy weight.
- Vaginal pessary: This small, reusable device goes into your vagina to support pelvic floor muscles and organs. Pessaries come in various sizes, and we work with you to decide on the right shape and size.
Surgery for pelvic organ prolapse
If symptoms are causing more serious problems, we offer surgeries and minimally invasive procedures to treat pelvic organ prolapse. Our urogynecologists specialize in female pelvic medicine and reconstructive surgery to restore pelvic floor support and improve your quality of life.
The goals of surgery are to repair the muscles and connective tissue in the pelvic floor to keep pelvic organs in their proper positions. We offer procedures that use your own tissue, donor tissue or surgical material when appropriate. Depending on your health goals and needs, some females may choose to have a hysterectomy (removal of the uterus) during the same procedure.
Minimally invasive procedures for pelvic organ prolapse
We have years of training and experience in the latest minimally invasive approaches and techniques, which use smaller incisions. Minimally invasive gynecologic surgery can help you recover faster and reduce your risk of complications.
Our minimally invasive approaches for pelvic organ prolapse include:
- Vaginal (for females): We access the affected pelvic organ by making one or more small incisions in the vagina.
- Laparoscopic: We make small incisions on the abdomen (belly) to access pelvic organs.
- Robotic-assisted: Robotic equipment can make more precise movements than a human hand. We use this equipment in a laparoscopic procedure to reposition organs and repair pelvic floor muscles.
Specialized care for bowel leakage
If you’re experiencing fecal incontinence (loss of bowel control) due to pelvic organ prolapse, our team offers specialized care. Learn more about the Women’s Accidental Bowel Leakage Program.
Clinical Trials for Pelvic Organ Prolapse Treatments
Our doctors participate in research that puts them at the forefront of care for people with pelvic organ prolapse. Clinical trials offer our eligible patients access to promising new diagnostic methods, nonsurgical treatments and surgical techniques before they’re widely available.
Penn Medicine’s Urogynecology program is one of a few research sites in the Pelvic Floor Disorders Network (PFDN), a research and clinical care network sponsored by the National Institutes of Health.
Request an Appointment
Our doctors provide pelvic organ prolapse treatment in our hospitals and clinics throughout Philadelphia, southeastern Pennsylvania and New Jersey. Call 800-789-7366 (PENN) or request a callback using our online form.