If one of your pelvic organs is displaced and drops from where it belongs in the lower belly, it can push against your vagina wall. When this happens, this is referred to as a pelvic organ prolapse. It is typically caused by weakened muscles that have been damaged in surgery or stretched out during childbirth. Organs that can be affected include your bladder, vagina, bowel and uterus.

This condition is much more common than most people know. It can cause mild discomfort, but typically it is not a big issue and may resolve on its own. However, if it is painful and causes problems, you may need pelvic prolapse surgery.

Causes and Symptoms of Pelvic Prolapse

The main cause of prolapse is weakened muscles, but it is usually compounded by several other issues. Your risk of the condition is increased by:

• Childbirth, especially if you gave birth to a large baby, had a difficult labor or had multiple babies (twins, triplets, etc.)
• Age, as you get older it is more common
• Excess weight, especially obesity or having cysts or fibroids which push on pelvic area
• Menopause, low estrogen levels and weakened productive organ tissue
• Heavy lifting, especially if repeated
• Straining, excessive pushing due to constipation
• Coughing, chronic or for an extended period of time
• Past pelvic surgery, such as bladder repair or hysterectomy

In addition, you may be more prone to prolapse and need pelvic prolapse surgery if you have one of the following conditions:

• Marfan syndrome, a condition inherited which causes problems with eyes, blood vessels and skeleton
• Ehlers-Danlos syndrome, an inherited ailment which negatively affects collagen proteins
• Joint hypermobility syndrome, a condition that causes loose joints

Symptoms

Most women who suffer from this condition do not experience symptoms. If they do, it is usually the pressure of the affected organ pushing against the wall of the vagina that causes the most discomfort. It can also negatively affect how the displaced organ functions. Other symptoms include:

• Pain with intercourse
• Pelvic pressure
• Lower back pain
• Vagina bleeding or spotting
• Urination urgency
• Bowel problems

Symptoms are more severe with jumping, standing and lifting.

Do You Need Surgery?

Sometimes prolapse does not resolve on its own. If your condition does not respond to lifestyle changes and other nonsurgical methods of treatment, you may have to undergo pelvic prolapse surgery. This will be largely determined by the severity of your symptoms, the organs affected and other ailments. Things your doctor will consider when determining if you should have surgery and what type includes:

• Family plans: E.g. do you plan on getting pregnant and having children or more children if you already have one?
• Age, as surgery at too young of an age may have a greater chance of recurrence and surgery at an older age requires consideration of other ailments.
• Existing health conditions, including medical conditions, obesity, infection and smoking, as they may affect surgery outcome.
• Potential complications, as surgery can induce symptoms like painful intercourse, urinary problems or pain in the pelvic area.

Surgery Choices for Types of Prolapse

There are pelvic prolapse surgery options that are minimally invasive and only require small incisions. Robot-assisted surgery, vaginal approaches and laparoscopic surgery assist in reducing your stay in the hospital.

Your surgeon will work with you to determine which type of surgery will be best for you and your conditions. Taking into consideration all factors, he will also be able to give you a good idea on the success of the procedure.

The different procedures include:

• Anterior prolapse, called cystocele, involves pushing your bladder and repairing tissue between it and your vagina so it stays in the right position. If there is excess connective tissue, your surgeon will remove it. If you are experiencing urinary problems like incontinence, you might undergo a bladder neck suspension as well.
• Posterior prolapse, called rectocele, involves connecting and repairing tissue between your rectum and vagina to reduce the discomfort. Excess tissue is removed to reduce bulge size.
• Vaginal vault prolapse, referred to apical and is called enterocele, involves corrective surgery where organs like the rectum, bladder and small bowel are placed back in their normal positions. This type of surgery can be performed through the abdomen or vaginally. If performed abdominally, the vagina is attached to the tailbone and mesh may be needed for additional support. If performed vaginally, ligaments from the uterine area will be used to fix the issue.
• Uterine prolapse, which involves a hysterectomy (uterus removal), can be performed unless you plan on becoming pregnant.

All types of pelvic prolapse surgery will require some recovery time, which is determined by the procedure. Typically, you will have to refrain from working for several weeks as well as avoid lifting, straining and strenuous exercise. Sexual intercourse will be restricted as well for few weeks.

Possible Risks Involved

Surgery, no matter the type, has some kind of possible risks. Your surgeon will go in detail on what to expect and what can happen. Complications include:

• Reactions to anesthesia
• Injury to nearby organs
• Excessive bleeding
• Painful sexual intercourse
• Vaginal bleeding
• Additional prolapse complications and symptoms
• Blood clots

You may be given drugs to reduce your infection or blood clot risks.