When the muscles and ligaments supporting a woman's pelvic organs weaken, the pelvic organs can slip out of place (prolapse). Pelvic organ prolapse can worsen over time, and you may need surgery to fix it. There are different types of pelvic organ prolapse. Some women develop pelvic organ prolapse after childbirth, a hysterectomy or menopause.

Read more about anterior prolapse (cystocele), posterior prolapse (rectocele), uterine prolapse, and small bowel prolapse (enterocele).

  • Team approach. Mayo Clinic experts trained in women's reproductive care (gynecology), urology and reconstructive surgery work together to evaluate and treat the different types of pelvic organ prolapse.
  • Experience and expertise. Highly skilled Mayo Clinic surgeons have extensive experience with procedures to repair pelvic organ prolapse, including minimally invasive techniques that require only small incisions, which may result in a shorter hospital stay and faster recovery.
  • Research. Mayo Clinic researchers continue to study ways to improve the treatment of pelvic organ prolapse. You benefit from this important research, and your treatment contributes to future knowledge.

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At Mayo Clinic in Arizona, doctors trained in gynecology, urology and urogynecology diagnose and treat women who have pelvic organ prolapse.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

At Mayo Clinic in Florida, doctors trained in gynecology, urology and urogynecology provide evaluation and treatment for women who have pelvic organ prolapse.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

At Mayo Clinic in Minnesota, doctors trained in gynecology, urology and gynecologic surgery diagnose and treat women who have pelvic organ prolapse.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Diagnosis of pelvic organ prolapse begins with a physical exam of your pelvic organs. The exam helps your doctor determine the type of prolapse and its severity. Your doctor also will ask you questions about medical and family history, including details about your symptoms.

Tests for pelvic organ prolapse may include:

  • Cotton swab test. Your doctor inserts a small, cotton-tipped applicator lubricated with anesthetic gel into your urine tube (urethra), and you're asked to strain. The applicator indicates loss of support to the urethra.
  • Bladder function test. This test measures your bladder's ability to store and empty urine. It helps your doctor determine the most appropriate type of surgery for bladder or urethral prolapse.
  • Pelvic floor strength tests. Your doctor will test the strength of your pelvic floor and sphincter muscles. Your doctor also will test the strength of muscles and ligaments that support the vaginal walls, uterus, rectum, urethra and bladder.
  • Magnetic resonance imaging (MRI). An MRI creates a detailed, 3-D image of your pelvis.
  • Ultrasound. An ultrasound helps your doctor view your kidneys, bladder and the muscles around your anus.
  • Cystoscopy. Doctors use cystoscopy to evaluate symptoms of urinary urgency, frequency, bladder pain or blood in the urine. Your doctor inserts a thin tube with a light and camera on the tip (cystoscope) into your urethra to view your urethra and bladder.

Your treatment will depend on the type of pelvic organ prolapse you have. Your doctor may recommend first treating your prolapse without surgery. In some people, if symptoms significantly affect quality of life, surgery is eventually necessary.

Medications

Menopause results in lower estrogen levels, which weakens the muscles of the vagina. Estrogen therapy may strengthen these muscles. However, some people shouldn't use estrogen, so discuss risks and benefits with your doctor. If you develop symptoms of one type of prolapse, you're more likely to develop other types. Mayo Clinic doctors try to correct all prolapse-related problems at one time.

Physical therapy

Physical therapy may include pelvic floor exercises using biofeedback to strengthen specific muscles of the pelvic floor. Biofeedback involves the use of monitoring devices with sensors that are placed in your vagina, rectum or on your skin. As you perform an exercise, a computer screen shows whether you're using the right muscles and the strength of each squeeze (contraction) so you learn how to do the exercises properly.

Surgery

Mayo Clinic doctors may use minimally invasive (laparoscopic) surgery, including robot-assisted surgery, to treat some types of pelvic organ prolapse. Minimally invasive surgery allows your surgeon to make smaller incisions and can shorten your hospital stay. Talk to your surgeon about why one procedure may be better for you than another, what the surgical approach will be, and what materials will be used. Also ask your surgeon about the long-term success for your planned procedure.

There are different surgical strategies for various types of prolapse:

  • Posterior prolapse. A posterior prolapse often involves the rectum and is sometimes called a rectocele. Your surgeon secures the connective tissue between your vagina and rectum to help keep the rectum in its proper position. Your surgeon also removes excess tissue.
  • Anterior prolapse. An anterior prolapse often involves the bladder and is sometimes called a cystocele. Your surgeon pushes your bladder up and secures the connective tissue between your bladder and vagina to keep the bladder in its proper position. The surgeon also removes excess tissue. If you have urinary incontinence, your doctor may use a bladder neck suspension or sling to support your urethra.
  • Uterine prolapse. If you don't plan to have more children, your surgeon may recommend surgery to remove the uterus (hysterectomy) to correct uterine prolapse.
  • Small bowel prolapse and vaginal vault prolapse. Small bowel prolapse is also sometimes called enterocele. In women who have had a hysterectomy, this type of prolapse is also called vaginal vault prolapse and may involve the bladder, rectum or small bowel. Your surgeon may perform corrective surgery through the vagina or abdomen.

    In a vaginal approach, your surgeon will use the ligaments that support the uterus to correct the problem. In an abdominal approach — which may be performed laparoscopically, robotically or as an open procedure — your surgeon attaches the vagina to the tailbone at the base of the spine, and small portions of synthetic mesh may be used to help support vaginal tissues. This type of surgery is called vaginal vault suspension.

Prolapse surgery repairs the tissue bulge. If the bulge doesn't bother you, surgery isn't needed.

Read more about treatment for anterior prolapse (cystocele), posterior prolapse (rectocele), uterine prolapse, and small bowel prolapse (enterocele).

Mayo Clinic doctors contribute to the understanding and treatment of pelvic organ prolapse through research and clinical practice. Researchers at Mayo Clinic focus on improving the diagnostic procedures and treatments used for all types of pelvic organ prolapse.

Publications

See a list of publications by Mayo Clinic doctors on pelvic organ prolapse on PubMed, a service of the National Library of Medicine.

Nov. 20, 2012