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What is pelvic organ prolapse?

What is a Prolapse?

A prolapse occurs when one of the female pelvic organs (i.e. the bladder, uterus, rectum or bowel) loses its supports and “falls” down into the vagina. A prolapse is a form of hernia into the vagina.

What are other names or terms for Prolapse?

Other terms include “dropped bladder”, “dropped uterus”, “dropped vagina” and “dropped rectum”. Other commonly used terms are cystocele, rectocele and enterocele.

What can Prolapse?

Any of the female pelvic organs (i.e. the uterus, bladder, rectum and bowel) adjacent to the vagina can prolapse or descend into the vagina.

The type of prolapse is named according to the organ that prolapses or the part of the vagina into which it prolapses.

The terminology used for the different pelvic organs that prolapse includes:

  • Cystocele – when the bladder prolapses
  • Rectocele – when the rectum or back passage prolapses
  • Enterocele – when the small bowel prolapses
  • Uterine prolapse- when the uterus prolapses

The terminology used for prolapse according to the location of the prolapse in the vagina includes:

  • Anterior compartment prolapse- when the front wall of the vagina prolapses (also known as a cystocele)
  • Posterior compartment prolapse –when the back wall of the vagina prolapses (also known as a rectocele or enterocele)
  • Apical prolapse –when the top of the vagina prolapses
    • This is also known as a uterine prolapse.
    • After a woman has had a hysterectomy, this is known as a vault prolapse.

Prolapse is also described according to its severity or grade, as well as according to its location in the vagina and which organ is protruding into the vagina.

Many women have a prolapse in more than one part of the vagina (or compartment) at the same time.

What is the most common site or area that Prolapses?

The bladder (cystocele or anterior compartment prolapse) is the site most commonly involved in vaginal prolapse.

  • About 80% of women with symptoms of prolapse will have a cystocele (bladder) prolapse alone or in combination with other sites of vaginal prolapse.
  • About 40% of women will have a rectocele (rectal prolapse) alone or in combination with other sites of vaginal prolapse.
  • About 30% of women will have the top of the vagina (uterus or vaginal vault in a woman after hysterectomy) involved in the prolapse.

How common is Prolapse and the need for treatment of Prolapse?

About 1/3 of all women who have had one or more children have symptoms of prolapse but only a small proportion seek treatment.

About 10% of women will have surgery for prolapse and/ or urinary incontinence at some time in their life. Up to 1/3 of the women who have surgery need repeat surgery. The need for surgery for prolapse increases with advancing age. The peak age group having surgery is between 40 to 50 years old.

How serious is a Prolapse?

Many women have a minor degree of prolapse that does not cause symptoms or problems.

Women with symptomatic prolapse do not commonly have serious complications related to their prolapse. The decision to treat the prolapse is usually related to a woman’s quality of life and the desire to get rid of the bothersome symptom of a vaginal bulge or lump that may be restricting a woman’s lifestyle and level of activity.

It is rare that prolapse causes severe complications in the urinary system due to blockage of drainage of urine from the bladder and kidneys that can result in poor bladder and kidney function and retention (inability to pass urine). Surprisingly women with these complications may not complain of many symptoms as the prolapse has been of gradual onset and they have been “putting up” with it for a long time.

The severity of the prolapse is determined by:

  • A woman’s own assessment of how bothersome her symptoms are
  • The doctor’s assessment of the “stage” or severity of the prolapse
  • The presence of any complications related to the prolapse such as
    • Poor bladder emptying / retention of urine
    • Recurrent urinary tract infection
    • Blockage of drainage of the kidneys and kidney impairment