Prolapse in Women
Pelvic organ prolapse is a condition where an organ falls out of its standard position. Structures such as the bladder, uterus, rectum, or vagina may be affected by prolapse. Roughly 30-40% of women experience some form of prolapse, typically after child birth, menopause, or a hysterectomy.
Prolapsed Bladder
Bladder prolapse, also known as cystocele or a fallen bladder, occurs when the bladder becomes unsupported and falls into the vagina. The front wall of the vagina holds up the bladder, and this support weakens with age and/or childbirth. Straining caused by heavy lifting or constipation can also cause bladder prolapse. A patient that has a prolapsed bladder may experience stress incontinence, pelvis pain, and complications upon urination.
There are four grades of bladder prolapse:
- Grade 1 – Mild – A small section of the bladder sinks into the vagina.
- Grade 2 – Moderate – The bladder approaches the opening of the vagina.
- Grade 3 – Severe – The bladder projects through the opening of the vagina.
- Grade 4 – Complete – The bladder is exposed outside the vagina. This occurs in the presence of another organ prolapse such as rectocele or uterine prolapse.
Mild cases of bladder prolapse may be treated nonsurgically. Estrogen replacement therapy is used to strengthen the muscles of the vagina, which can weaken upon menopause. A pessary can be used to hold the bladder in place. For more severe prolapsed bladder, surgery may need to be performed to place the bladder in its correct position.
Rectocele
A rectocele, or posterior prolapse, is the protrusion of the front wall of the rectum into the back wall of the vagina. This is caused by the weakening of the fascia, or the fibrous tissue that divides the vagina from the rectum. The fascia can weaken from child birth, reoccurring constipation, or a hysterectomy. Rectocele is a common condition upon women, although it is frequently diagnosed based upon a physical exam rather than symptoms.
Treatment for rectocele is dependent on its severity. If the patient experiences little to no symptoms, a urologist will monitor the rectocele’s progress over time. A pessary or surgical treatment is recommended for patients with more serious cases.
Uterine Prolapse
A prolapsed uterus is caused by the weakening of muscles, ligaments, and tissue near the organ. Childbirth and age may weaken these structures. As the patient ages, the amount of estrogen the body produces is reduced, which contributes to the weakening of the muscles and tissues. Uterine prolapse is generally present with another form of prolapse, such as rectocele or cystocele.
Muscle relaxation or weakness may cause the uterus to drop in several stages. There are four stages of uterine prolapse:
- First degree – The cervix drops into the vagina.
- Second degree – The cervix nears the opening of the vagina.
- Third degree – The cervix protrudes outside of the vagina.
- Fourth degree – The whole uterus is outside the vagina.
Symptoms of a prolapsed uterus include pressure or bloating near the pelvis, difficulty during urination or a bowel movement, the feeling that something is exiting the patient’s vagina, and painful intercourse. A urologist will diagnose a patient with uterine prolapse based on their symptoms and a physical exam. Treatment is contingent on the degree to which the structures surrounding the uterus have weakened. Estrogen treatment may be used to build up the strength that has been lost. Surgery such as a hysterectomy may be performed for severe cases. A procedure to fix the vagina and other sagging structures can also be done.
Vaginal Prolapse
Vaginal vault prolapse affects the upper section of the vagina. The vagina becomes misshapen, and drops or sags to the vaginal canal or the outer portion of the vagina. Vaginal prolapse results in the weakness of vaginal and pelvic muscles and tissues. This condition can happen on its own or with another prolapsed structure such as the urethra, bladder, rectum, or small bowel. Vaginal prolapse mostly affects women who have had a hysterectomy. Vaginal prolapse results in the weakness of vaginal and pelvic muscles and tissues.
Symptoms of vaginal vault prolapse include backache, urinary incontinence, pelvic heaviness, bulging in the vaginal canal that may affect walking, and vaginal bleeding. Surgery is performed for the treatment of vaginal prolapse. In this surgery, the top of the vagina is affixed to the lumbar spine, ligaments of the pelvis, or the abdominal wall. A urologist will use artificial material or the patient’s tissue to adhere the vagina to these structures.
Urologists at AUUA
The specialized doctors of Academic Urology are leaders in their fields, and they have the experience and knowledge needed to treat various urologic disorders. Our seven offices are located throughout Arizona, which allows patients easy access to the best urologic care. Call us to learn more about the treatment options we offer.
