Pelvic Organ Prolapse is when the organs inside of the pelvis, such as the uterus, urethra, or bladder, protrude toward or through the opening of the vagina. This is caused by a weakness in the pelvic floor, muscles, and the fibromuscular connective tissue that supports and surrounds the vagina, rectum, bladder, and uterus. The pelvic floor’s job is to hold these pelvic organs in place, but when it weakens the organs can fall out of their positions and stop functioning normally. When the fibromuscular connective tissue sheets that separate the vagina, bladder and rectum are damaged, vaginal hernias develop.
Prolapse Symptoms
The most obvious symptom of vaginal prolapsed is a bulge protruding from the opening of the vagina. Additional symptoms of vaginal prolapsed are pelvic pressure, discomfort, feeling as if something is falling out, difficulty emptying the bladder, unwanted urine leakage, difficulty emptying the rectum, fecal incontinence and experiencing a sense of looseness or discomfort during sexual intercourse.
Causes of Pelvic Organ Prolapse
Even though more than 40% of all women experience some degree of prolapse in their lifetime, 14 million in the US alone, the exact cause is unknown. However, risk factors include pregnancy, vaginal delivery, hysterectomy, obesity, chronic cough, chronic constipation, repetitive heavy lifting, menopause and genetic connective tissue weakness.
Diagnosing Prolapse
The presence and severity of vaginal prolapse is determined during a pelvic exam. During this exam, the anterior vaginal wall, posterior vaginal wall, top of the vagina and uterus are each evaluated for prolapse. After the exam, a stage from 0 to IV is assigned. A stage 0 prolapse means there are no prolapsed organs identifiable. A stage I prolapse means that the vaginal wall bulges down to 3 centimeters inside the opening of the vagina. A stage II prolapse means that the vaginal wall comes to or slightly through the opening. A stage III prolapse is when the vaginal wall protrudes several centimeters outside of the vagina. A stage IV prolapse is when the entire vaginal wall protrudes through the opening.