Prolapse Treatment — Pelvic Organ Prolapse Repair
Written & medically reviewed by Dr. Shaivalini Kamarapu
MBBS · MS (Obstetrics & Gynaecology) · Fellowship in Reproductive Medicine · 20+ years of clinical experience
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What is prolapse?
Vaginal prolapse is the loss of support to the pelvic organs that surround the vagina, resulting in the bulging (dropping) of the bladder, urethra, rectum or uterus into the vagina. It may also be associated with urinary incontinence (leaking urine on cough or other stressful movement) or fecal incontinence (leaking stools).
What are the types of prolapse?
Prolapse can involve any of the walls and/or the top of the vagina. The types include:
Anterior compartment prolapse
The most common type — involves the herniation of the bladder and/or urethra into the vagina, called a cystocele or cysto-urethrocele.
Posterior compartment prolapse
Involves the herniation of the rectum into the back wall of the vagina, called a rectocele.
Uterine prolapse (apical compartment)
The second most common type of prolapse — occurs when the uterus herniates into the vagina.
Vaginal vault prolapse (apical compartment)
Occurs following hysterectomy, when the top of the vagina loses its support and inverts into the vagina like a stocking turned inside out.
Severity varies from a small hernia to a bulge that comes out of the vagina.
How common is prolapse?
Prolapse is likely to affect about 1 in 3 women who have had children. However, severity varies widely, and only about 1 in 9 women (11%) may need surgery for the problem.
What are the causes of prolapse?
Pregnancy and childbirth
Aging and hormonal changes
Genetic factors
What are the symptoms of prolapse?
Many patients are asymptomatic. Symptoms include:
A feeling of a vaginal bulge or a lump in the vagina, sometimes extending outside the vagina
Discomfort during sexual intercourse
A dragging sensation in the vagina and lower back
With cystocele: urinary symptoms such as a slow urinary stream, a feeling of incomplete bladder emptying, urinary frequency or urgency, and stress urinary incontinence
With rectocele: difficulty emptying the bowel, or the need to press on the back wall of the vagina to pass stools
How can prolapse be treated?
Your doctor will perform a thorough physical examination, including a vaginal examination, to understand the extent of the condition and identify the specific support defect involved. A range of non-surgical and surgical treatments are available.
Non-surgical treatments
- Physiotherapy
- Pessaries
If left untreated, prolapse tends to worsen over time and will eventually need surgical intervention.
Surgical treatment
The goal is to identify and surgically address all sites of weakness within the vaginal wall, minimising the risk of recurrence. These repairs are often combined with treatment for urinary or fecal incontinence. Most surgical repairs are performed through the vaginal route, though a laparoscopic approach may be used for select cases, such as recurrent prolapse after vaginal hysterectomy.
Obliterative surgery
Reconstructive surgery