women s health issues
Pelvic Organ Prolapse (POP)
Types and Symptoms
Pelvic organ prolapse is essentially a hernia (an opening or weak area in tissue), through which organs protrude abnormally because supporting tissue is weakened. The different types of pelvic organ prolapse are named according to the organ affected. The back wall of the vagina: Prolapse of the rectum (rectocele) or small intestine (enterocele) The front wall of the vagina: Prolapse of the bladder (cystocele) or urethra (urethrocele) The top of the vagina: Vaginal (apical) prolapse The uterus: Prolapse of the uterus (uterine prolapse) Often, a woman has more than one type. In all types, the most common symptom is a feeling of heaviness, fullness, or pressure in the area of the vagina. A woman may feel as if she is sitting on a ball or that the uterus, bladder, or rectum is bulging or dropping out of her vagina. Symptoms tend to occur when women are standing or sitting upright, straining, or coughing and to disappear when they are lying down and relaxing. For some women, sexual intercourse is painful. Mild cases may not cause symptoms until the woman becomes older. Prolapse of the rectum (rectocele), small intestine (enterocele), bladder (cystocele), and urethra (urethrocele) are particularly likely to occur together. A urethrocele and cystocele almost always occur together. Damage to the pelvic floor may affect the urinary tract. As a result, women who have pelvic organ prolapse may have problems controlling urination, resulting in urine leaking out involuntarily ( Urinary Incontinence in Adults ) or problems completely emptying the bladder ( A cystocele develops when the bladder drops down and protrudes into the front wall of the vagina. It results from weakening of the connective tissue and supporting structures around the bladder. When a urethrocele and cystocele occur together, they are called a cystourethrocele. Women with either of these disorders may have urinary incontinence. A rectocele develops when the rectum drops down and protrudes into the back wall of the vagina. It results from weakening of the muscular wall of the rectum and the connective tissue around the rectum. A rectocele can make having a bowel movement difficult and may cause Constipation in Adults . Women may be unable to empty their bowels completely. Some women need to place a finger in their vagina and press against the rectum to have a bowel movement. An enterocele develops when the small intestine and the lining of the abdominal cavity (peritoneum) bulge downward between the vagina and the rectum. It occurs most often after the uterus has been surgically removed (hysterectomy). An enterocele results from weakening of the connective tissue and ligaments supporting the uterus or vagina. An enterocele often causes no symptoms. But some women feel a sense of fullness or pressure or pain in the pelvis. Pain may also be felt in the lower back. In prolapse of the uterus, the uterus drops down into the vagina. It usually results from weakening of the connective tissue and ligaments supporting the uterus. The uterus may bulge in the following ways: Only into the upper part of the vagina Down to the opening of the vagina Partly through the opening All the way through the opening, resulting in total uterine prolapse (procidentia) How far down the uterus drops down determines how severe symptoms are. At first, prolapse of the uterus may cause mild or no symptoms. When prolapses worsens, the first symptom most women report is feeling a bulge at the opening of the vagina. They may also have pain in the lower back or over the tailbone, difficulty having a bowel movement, and pain during sexual intercourse, as well as a feeling of heaviness or pressure—a feeling that pelvic organs are dropping out. Total uterine prolapse can cause pain during walking. Sores may develop on the protruding cervix (the lower part of the uterus) and cause bleeding, a discharge, and infection. Women may have problems controlling urination, resulting in urine leaking out involuntarily ( Urinary Incontinence in Adults ). Or women may not be able to empty their bladder completely or to urinate ( Constipation in Adults can occur. In prolapse of the vagina, the upper part of the vagina drops down into the lower part, so that the vagina turns inside out. The upper part may drop part way through the vagina or all the way through, protruding outside the body and causing total vaginal prolapse. Usually, a cystocele or rectocele is also present. Total vaginal prolapse may cause pain while sitting or walking. Sores may develop on the protruding vagina and cause bleeding and a discharge. Like prolapse of the uterus, prolapse of the vagina can cause problems with urination. Having a bowel movement may also be difficult. 