Prolapse
What is Prolapse?
Prolapse, which means "to slip out of place," is used to describe an organ that has moved out of its normal position. Pelvic organ prolapse refers to slippage of any one or more of the pelvic organs, including the uterus, vagina, bladder, or rectum, because the surrounding muscles, ligaments, and structures no longer provide adequate support.
Twenty to 30 percent of women suffer from some degree of prolapse, according to estimates from Brigham & Women's Hospital, and one in 11 women will require surgery for pelvic organ prolapse in their lifetime (most of them older than age 40), according to estimates from the Mayo Clinic.
There are several types of pelvic organ prolapse, depending on which organ has “slipped”:
Uterine Prolapse
Your uterus is held in place by your pelvic floor muscles and ligaments. During a vaginal birth or repeated vaginal births, or over time with aging, the muscles and ligaments can weaken or become damaged. Loss of estrogen due to menopause, the birth of a large child, repeated straining during bowel movements, chronic coughing, or even heavy lifting can also weaken the muscles. In uterine prolapse, the uterus drops from its position in the pelvic region and protrudes into the vagina.
Symptoms include:
- A lump or bulge at the opening of the vagina
- Recurrent urinary tract infections
- A feeling of pressure in the vagina or pelvis
- Urinary and bowel dysfunction
- Sexual dysfunction or painful intercourse
- Back pain or pelvic discomfort
Vaginal Vault Prolapse
With vaginal vault prolapse, the top of the vagina falls toward the vaginal opening. This sometimes happens after a hysterectomy (removal of the uterus) because the uterus provides support for the top of the vagina. Vaginal vault prolapse can also be caused by a herniated small bowel (known as enterocele), where a bulge in the intestine pushes against the vaginal skin.
Symptoms of vagina vault prolapse include urinary incontinence or problems with bowel function.
Bladder Prolapse
Prolapse of the bladder, called cystolcele, occurs when the front wall of the vagina slips out of place. It is often accompanied by prolapse of the urethra, also known as urethocele. When both conditions occur together, the result is called cystourethrocele.
Common symptoms of bladder or urethra prolapse include urinary stress incontinence (leaking of urine) while running, sneezing or coughing, but in more severe cases the prolapse can actually prevent urine from coming out, as the bulge blocks the flow.
Rectal Wall Prolapse
Prolapse of the rectal wall (also the back wall of the vagina) is known as rectocele. If the rectal wall becomes weak, it can push against the back wall of the vagina, creating a bulge. Symptoms can include difficulty with bowel movements.
Prolapse of the rectal wall is different from rectal prolapse, an uncommon condition where the rectum (the final section of the large intestine) turns itself inside out and protrudes out of the anal opening. Rectocele, on the other hand, refers to weakness in the tissues between the vagina and the rectum.
Symptoms of rectal prolapse are similar to those of hemorrhoids, but the condition starts higher in the rectum. They include tissue protruding from the rectum and pain during bowel movements, among other things.
This information is not intended to substitute the recommendations of your healthcare providers. Women’s Health Foundation disclaims any liability for the decisions you make based on this information.
