Pelvic organ prolapse when the pelvic organs (bladder, rectum, or uterus) push into the vaginal canal due to the weakening of pelvic muscles. Specific conditions include:

• Cystocele prolapse is the protrusion of the bladder into the vaginal canal. Some patients have symptoms of incontinence without bladder prolapse, and some patients have bladder prolapse without incontinence.

• Apical prolapse is the protrusion of the uterus or the top of the vagina (post-hysterectomy patients) into the vaginal canal.

• Rectocele prolapse is the protrusion of the rectum into the vaginal canal.

Approximately 75 percent of prolapse can be attributed to pregnancy and childbirth. According to one study, after the second pregnancy, a woman is eight times more likely to develop prolapse, compared to someone who has never had children. Obesity and advanced age also increase the risk of prolapse.

Although many women who have pelvic organ prolapse do not have symptoms, the most common and bothersome symptom is pressing of the uterus or other organs against the vaginal wall. The pressure on your vagina may cause minor discomfort or problems in how your pelvic organs function.

Symptoms of pelvic organ prolapse include:

• A feeling of pelvic pressure

• A feeling as if something is actually falling out of the vagina

• A pulling or stretching in the groin area or a low backache

• Painful intercourse

• Spotting or bleeding from the vagina

• Urinary problems, such as involuntary release of urine (incontinence) or a frequent or urgent need to urinate, especially at night

• Problems with bowel movements, such as constipation

Symptoms of pelvic organ prolapse are worsened by standing, jumping, and lifting and usually are relieved by lying down.

The choice of treatment depends upon the patient’s preferences. Treatment plans may include the following:

• Expectant management or no treatment is an option for women who can tolerate their symptoms and prefer to avoid treatment.

• Conservative management can involve utilizing a vaginal pessary, which is a silicone device inserted vaginally to support the pelvic organs. The pessary must be removed and cleaned on a regular basis. Approximately 40 percent of women discontinue the use of a pessary within one or two years of use. Another conservative option is pelvic floor muscle exercises; however, this has been helpful in only a small number of women according to several studies.

• Surgical management is offered to women with symptomatic prolapse and who have failed or declined conservative management options. Surgery is usually delayed until childbearing is complete.

The type of surgical procedure conducted depends on the amount (degree) of prolapse and the location. They include:

• Cystocele repair refers to the repair of the bladder prolapse. This can be done through a vaginal surgery and involves the reconstruction of the vaginal wall and tissue between the bladder and the vagina. The procedure can be performed with and without the use of transvaginal synthetic mesh.

• Rectocele repair refers to the repair of rectum prolapse. This repair can be performed through a vaginal surgery and involves the reconstruction of the vaginal wall and tissue between the rectum and the vagina. This can be done with and without the use of transvaginal synthetic mesh.

• Apical repair refers to the repair of uterine prolapse or prolapse of the top (apex) of the vagina. This involves much more complex techniques to repair the prolapse. There are two common techniques, which involve fixating the top of the vagina to two different ligaments in the lower pelvic region.

Bladder prolapse repair and rectum prolapse repair often use a large segment of synthetic mesh to separate the bladder and the vagina or the rectum and the vagina, respectively. 

Previously, transvaginal mesh use was associated with improved short-term outcomes for repair of bladder prolapse, as compared with procedures without the use of mesh. However, concerns have been raised regarding the safety of transvaginal synthetic mesh. The most common complication of transvaginal mesh placement is mesh erosion, which is usually treated successfully with mesh removal (excision). The rate of mesh erosion has been shown to be as high as 30 percent. 

The FDA has issued several documents on the use of reconstructive materials for female pelvic floor surgery. The conclusions to date have been that transvaginal placement of these materials are of uncertain effectiveness and are associated with safety risks. 

In contrast, use of synthetic mesh for uterus prolapse repair or for full-length slings (for incontinence treatment) are considered safe and effective.

Before undergoing surgery, you will likely have many questions for your physician or surgeon. View our recommended questions to ask - and background information to help you weigh the answers - below or download a printable version. 

Women need to be their own best advocate, which is why getting a second opinion is always good practice. Since there are different surgical options for treating pelvic organ prolapse, getting a second opinion is a way you can ask questions about how the surgery will be performed, the recovery time, and possible complications.