By Mayo Clinic Staff
When the muscles and ligaments supporting a woman's pelvic organs weaken, the pelvic organs can slip out of place and create a bulge in the vagina (prolapse). Women most commonly develop pelvic organ prolapse years after childbirth, after a hysterectomy or after menopause. This bulge can worsen over time. If you have symptoms, see your health care provider.
- A wide array of specialists work together to provide the best care for you. A multidisciplinary team of Mayo Clinic experts trained in female pelvic floor medicine and reconstructive surgery including both gynecologists and urologists evaluate and treat the different types of pelvic organ prolapse. Your treatment options might include nonsurgical or surgical interventions.
- Every year, highly skilled Mayo Clinic surgeons treat thousands of women with pelvic organ prolapse. Our doctors have extensive experience with repair procedures, including minimally invasive techniques that require only small incisions, which may result in a shorter hospital stay and faster recovery.
- Our mission to find and share better medical expertise means close contact with people researching to discover better methods to diagnose and treat different types of pelvic organ prolapse. You benefit from this important research, and your treatment contributes to future knowledge.
- We take the time to listen closely. We get to know you and your concerns completely, and explain your options in plain language. Long experience has shown us that understanding and considering all your issues as we develop a treatment plan together simply works better.
Mayo Clinic in Rochester, Minn., ranks No. 1 for gynecology in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Jacksonville, Fla., is ranked among the Best Hospitals for gynecology by U.S. News & World Report.
Diagnosis of pelvic organ prolapse begins with your history and a physical exam of your pelvic organs to help your health care provider determine the type of prolapse.
Beyond this office visit, some additional tests might be necessary in some situations. Ask your health care provider why each test is being done so that you can understand the different decisions you and your provider can make about your management options.
Tests for pelvic organ prolapse might include:
- Bladder function tests. Some tests are as simple as finding out whether your bladder leaks when it is put back into place at the time of your physical exam. Other tests might measure how well your bladder empties. Seeing these results can help you and your doctor determine the most appropriate type of management for prolapse.
- Pelvic floor strength tests. Your doctor will test the strength of your pelvic floor and sphincter muscles at the time of your physical examination. This tests 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 and is useful only in complex cases.
- Ultrasound. An ultrasound helps your doctor view your kidneys, bladder and the muscles around your anus and is useful only in complex cases.
Your treatment will depend on the severity of your symptoms. If your prolapse does not bother you, your health care provider might recommend treating your prolapse without surgery. If symptoms get worse and significantly affect your quality of life, surgery might be needed.
Weakness of the pelvic floor often affects more than one area. For example, if you develop symptoms of one type of prolapse, you're more likely to develop other types. Mayo Clinic pelvic floor specialists try to correct all prolapse-related problems at one time.
Many women with prolapse are also in menopause. Menopause results in lower estrogen levels, which can lead to vaginal dryness. If vaginal dryness is a problem for you, you might want to discuss estrogen therapy with your health care provider.
Some women might be treated with estrogens before a surgical procedure. However, some people shouldn't use estrogen, so discuss the risks and benefits with your health care provider.
Physical therapy might be recommended, with 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. Long-term strengthening of these muscles is the most important factor in reducing your symptoms. Biofeedback teaches you how to use your own muscles to keep them strong.
Some women might prefer a nonsurgical option for prolapsed organs. Pessaries are silicone devices that come in a variety of shapes and sizes. They're placed vaginally to hold the pelvic organs in place.
Mayo Clinic doctors might use vaginal approaches or other 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 might 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.
Depending on the location of your prolapse, there are different surgical strategies for various types of prolapse:
- Posterior prolapse. A posterior prolapse often involves the rectum and is called a rectocele. Your surgeon secures the connective tissue between your vagina and rectum to reduce the size of the bulge. Your surgeon also removes excess tissue.
Anterior prolapse. An anterior prolapse often involves the bladder and is 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 might recommend a bladder neck suspension or sling to support your urethra.
- Uterine prolapse. If you don't plan to have more children, your surgeon might recommend surgery to remove the uterus (hysterectomy) to correct uterine prolapse.
Vaginal vault prolapse. In women who have had a hysterectomy, the prolapse is at the apex, or an apical prolapse. Also known as a vaginal vault prolapse, this type of prolapse might involve the bladder, rectum and, commonly, the small bowel, where the bulge is called an enterocele. Your surgeon might 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 might be performed laparoscopically, robotically or as an open procedure — your surgeon attaches the vagina to the tailbone, and small portions of synthetic mesh might be used to help support vaginal tissues. This particular type of surgery is called sacrospinous fixation.
Other vaginal vault suspensions might also be recommended. Talk to your doctor about the use of mesh materials if you have concerns.
Remember that prolapse surgery only repairs the tissue bulge. If the bulge doesn't bother you, surgery isn't needed. Recurrent prolapse is common, as surgery does not repair the underlying weakened tissues.
Prolapse is the result of weakened pelvic floor tissues that create a bulge, like a hernia. Anything you do to stop weakening these tissues is protective against your bulge getting worse or returning after a surgical repair, including:
- Quitting smoking
- Treating conditions that might put strain on the pelvic floor, such as a chronic cough or constipation
- Losing weight
- Strengthening your core and your pelvic floor
Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.
At Mayo Clinic's campus 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.
- U.S. Patients
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At Mayo Clinic's campus 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.
- U.S. Patients
- International Patients
At Mayo Clinic's campus 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.
- U.S. Patients
- International Patients
See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.
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.
See a list of publications by Mayo Clinic doctors on pelvic organ prolapse on PubMed, a service of the National Library of Medicine.
July 28, 2015
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- Pelvic organ prolapse. American Urogynecologic Society. http://www.voicesforpfd.org/p/cm/ld/fid=6. Accessed July 18, 2015.
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- Fashokun TB, et al. Pelvic organ prolapse in women: A diagnostic evaluation. http://www.uptodate.com/home. Accessed June 20, 2015.
- Walters MD, et al. Laparoscopic and robotic surgery for pelvic organ prolapse and stress urinary incontinence. In: Urogynecology and Reconstructive Pelvic Surgery. 4th ed. Philadelphia, Pa.; Saunders Elsevier. 2015. www.clinicalkey.com. Accessed June 21, 2015.
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- Lightner DJ (expert opinion). Mayo Clinic, Rochester, Minn. June 22, 2015.
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