Pelvic organ prolapse care at Mayo Clinic
- Your Mayo Clinic care team. A multidisciplinary team of Mayo Clinic experts trained in female pelvic floor medicine and reconstructive surgery evaluate and treat different types of pelvic organ prolapse. This team includes gynecologists and urologists. Each year, Mayo Clinic doctors care for nearly 3,000 women with pelvic organ prolapse.
- Advanced treatment. Our doctors have extensive experience with repair procedures, including minimally invasive techniques that require only small incisions, which might result in a shorter hospital stay and faster recovery. Your treatment options might include nonsurgical or surgical interventions.
Mayo Clinic in Rochester, Minn., Mayo Clinic in Phoenix/Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., rank among the Best Hospitals for gynecology in the U.S. News & World Report Best Hospitals rankings.
Mayo Clinic in Minnesota ranks No. 1 for urology in the U.S. News & World Report Best Hospitals rankings.
Diagnosis at Mayo Clinic
Diagnosis of pelvic organ prolapse begins with your medical history and a physical exam of your pelvic organs. This can help your health care provider determine the type of prolapse, such as bladder, rectum or uterine.
Some tests might also be needed. Ask your health care provider to explain why each test is being done. Tests for pelvic organ prolapse might include:
- Bladder function tests. Some tests are as simple as finding out whether your bladder leaks when it's 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 will use a magnetic field and radio waves to create detailed images of your pelvis. This is useful only in complex cases.
- Ultrasound. This imaging method will use high-frequency sound waves to produce images of your kidneys, bladder and the muscles around your anus. An ultrasound is useful only in complex cases.
Treatment at Mayo Clinic
Your treatment will depend on the severity of your symptoms. If your pelvic organ prolapse doesn't 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 one of your pelvic organs is prolapsed, you're more likely to develop another type of pelvic organ prolapse. Mayo Clinic pelvic floor specialists try to correct all prolapse-related problems at one time.
Estrogen might be a treatment option for certain women with prolapse. Many women with prolapse are also in menopause, which results in lower estrogen levels. Too little estrogen can weaken pelvic floor muscles and lead to vaginal dryness.
Some women might be treated with estrogens before a surgical procedure. However, some people shouldn't use systemic estrogen. Discuss the risks and benefits with your health care provider. The use of vaginal estrogen generally isn't a problem.
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 that 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 robotic 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:
- 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 children in the future, 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. This type of surgery is called sacrospinous fixation.
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 surgery is called sacral colpopexy. If you're concerned about the use of mesh materials, talk to your surgeon about the benefits and potential risks.
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 doesn't repair the underlying weakened tissues.
Prolapse is the result of weakened pelvic floor tissues that create a bulge, such as a hernia. Anything you do to stop weakening these tissues can help your condition from 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
- Avoiding heavy lifting
- Not straining during bowel movements
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Nov. 10, 2020