Pelvic organ prolapse is caused by weakening or injury to the pelvic floor muscles. These muscles act like a hammock to keep the pelvic organs in place. Pregnancy and childbirth are the main causes of POP but it can also be seen with normal aging, menopause and obesity.

Diagnosis of pelvic organ prolapse is made by taking a through history and performing a pelvic exam. Your provider will assess descent of each of the pelvic organs and grade the amount of prolapse. The provider will also measure the amount of urine left in your bladder after urination called a postvoid residual (PVR).

The need for treatment for POP depends on symptoms and severity. Reasons to treat POP include pelvic pain, inability to urinate or defecate, pain with intercourse and other urinary symptoms.

Pelvic floor physical therapy (PFPT)

PFPT will teach patients exercises to improve pelvic floor strength.

Weight loss

Maintaining a healthy weight decreases pressure on the pelvic floor.

Vaginal estrogen

Replacement of vaginal estrogen strengthens the pelvic floor. If it does not decrease the symptoms of POP it may still be helpful prior to prolapse surgery to improve the vaginal tissue.

Pessary

A pessary is a soft, flexible device that is inserted in the vagina to help support the pelvic organs.

Surgical management

There are several surgical treatments for pelvic prolapse depending on your anatomy and degree of prolapse. If you have symptomatic anterior or posterior prolapse your provider may discuss with you an anterior and/or posterior repair. With this surgery, the connective tissue between the bladder or rectum is used to reinforce the weak pelvic floor and reduce the vaginal bulge. Another option for surgical management is a sacrocolpopexy. This procedure is more invasive and requires removal of the uterus if the patient has not already had a hysterectomy. A sacrocolpopexy is typically done as a robotic surgery. The surgeon will use mesh to lift the top of the vagina and attach it to a ligament near the tailbone.