Pelvic Organ Prolapse

Pelvic floor or vaginal prolapse is a condition that affects many women. It is associated with weakness of the muscles and ligaments that hold the pelvic organs in their proper place. The pelvic floor is the group of muscles, ligaments and tissues that support the pelvic organs, which include the uterus, bladder and rectum. In some cases, these organs may protrude (drop) down through the vagina and create a vaginal bulge.

Pelvic Organ Prolapse - Rose Khavari, MD

Rose Khavari, MD, director of research at Houston Methodist’s Center for Restorative Pelvic Medicine, explains how pelvic organ prolapse occurs, describes prolapse symptoms and provides treatment examples.

Types of Pelvic Organ Prolapse 

Pelvic floor prolapse is often referred to as a hernia, and some women may even have more than one type. Each type of prolapse has a different name, depending on which organ is affected. 
  • Cystocele (also known as bladder prolapse) -This is one of the most common types of pelvic organ prolapse, leading to a bulge or dropping of the anterior vaginal wall, with the bladder falling within the bulge. Under normal conditions in women, the bladder is held in position by a hammock of supportive pelvic floor muscles and ligaments. When these muscles and tissues are stretched or weakened, the back of the bladder can sag through this layer of muscles and ligaments and into the vagina. In severe cases, the sagging bladder will appear at the vaginal opening and can even protrude (drop) through it. 
  • Urethrocele -This involves prolapse of the female urethra into the vagina. 
  • Uterine prolapse -The uterus can drop into the vagina if the connective tissues and ligaments that support the uterus are severely weakened. The uterus may fall and bulge into the upper part of the vagina, the middle of the vagina or all the way through the opening of the vagina (total uterine prolapse, or procidentia). 
  • Vaginal prolapse -The vaginal walls begin to drop, causing the vagina to turn inside out. This can include anterior vaginal prolapse (cystocele), prolapse of the top of the vagina (vaginal vault prolapse) or posterior vaginal prolapse (rectocele). 
  • Vaginal vault prolapse -The upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina. This condition is usually caused by weakness or damage to ligaments and muscles that support the top of the vagina. It happens in women who have had a hysterectomy. 
  • Rectal prolapse -The rectum, the lower portion of the colon, turns itself inside out and protrudes through the anus. While this condition most often affects women, it can also occur in men. 
  • Enterocele -The small intestines bulge downward between the uterus and the rectum or bulge down on the top of the vagina (in women with a previous hysterectomy). An enterocele results from the weakening of connective tissues and ligaments at the top of the vagina. This particular condition has no symptoms, but some women may experience pressure or pain in the pelvis or lower back. 
  • Rectocele -The rectum bulges into the posterior wall of the vagina. This condition can make a bowel movement extremely difficult, and the woman may feel as though she is constipated or not emptying with bowel movements. 

Causes of Pelvic Organ Prolapse
The causes of pelvic organ prolapse are similar to those that contribute to urinary incontinence. The primary cause is weakening of the pelvic-floor muscles and connective tissues that support the uterus and vagina. Vaginal childbirth may cause nerve injury to the pelvic floor muscles, which results in pelvic floor weakening. Few women have symptoms of prolapse initially because other muscles around the pelvic floor can help to compensate. As a woman ages, the muscles lose some of their strength, and the prolapse becomes more noticeable. Risk factors that have been linked to pelvic organ prolapse may include the following:
  • Vaginal childbirth
  • Advancing age or menopause
  • Heavy lifting
  • Chronic coughing
  • Constipation
  • Obesity
  • Previous pelvic surgery
  • Neurological problems -such as injury to the spinal cord

Symptoms of Pelvic Organ Prolapse
Pelvic organ prolapse has many symptoms, but the most reliable is the presence of a bulge outside of the vagina. Other symptoms of prolapse include difficulty with urination, or constipation and the sensation of something falling out of the vagina. Additional symptoms may include these issues:
  • Stress incontinence - urine passes when you cough or laugh, causing pressure within the abdomen
  • Frequent urinary tract infections (UTIs)
  • Development of urge incontinence - a sudden and immediate need to urinate, in which an accident can occur
  • Frequent need to urinate or difficultly urinating or having a bowel movement
  • Discomfort or pain in the vagina, pelvis, lower abdomen, groin or lower back
  • Heaviness or pressure in the vaginal area
  • Tissue protruding from the vagina that may be tender or bleeding
  • Painful intercourse

Symptoms of rectal prolapse depend on the amount of prolapse:
  • Early in the course of rectal prolapse, the rectum does not protrude through the anus. You may have difficulty evacuating stool and may experience chronic pelvic pain.
  • With progression of the condition, the rectum protrudes through the anus. You may experience anal pain, bleeding and a mass outside the anus. These symptoms are very similar to a prolapsing hemorrhoid.
  • Rectal prolapse may cause accidental bowel leakage or difficulty controlling gas and stool. This incontinence may be reversible with appropriate therapy.

Treating Pelvic Organ Prolapse

Treatment for pelvic organ prolapse usually depends on the severity of the symptoms and how much these symptoms interfere with daily activities and general quality of life. Various types of treatment may include these procedures:
  • Pelvic floor physical therapy or Kegel exercises
  • Pessaries (vaginal support devices)
  • Minimally invasive reconstructive surgery (vaginal, laparoscopic, robotic)

Pessaries for Pelvic Organ Prolapse — Dr. Danielle Antosh

Danielle Antosh, MD, director of Houston Methodist’s Center for Restorative Pelvic Medicine, describes how pessaries are used to treat patients with pelvic organ prolapse.

Some types of prolapse, if left untreated, may get worse. In rare cases, severe prolapse can cause urinary retention, which may lead to kidney damage or infection.

These issues can be embarrassing, but they can be resolved, and you can regain your quality of life. Your first step is to talk with one of our specialists.

Houston Methodist combines the expertise of urogynecologists — specialty physicians trained in the areas of urology and gynecology — as well as traditional gynecologists and colorectal surgeons to provide the most advanced care available for women and men with problems related to the lower urinary tract and the pelvic floor. The Center for Restorative Pelvic Medicine at Houston Methodist Hospital is the first of its kind in the Greater Houston area and is one of the few centers in the country that offers a single-center location for the diagnosis and treatment of complex pelvic-floor disorders.


Our physicians at Houston Methodist specialize in treating pelvic organ and rectal prolapse at the following convenient locations: