Am Fam Physician. 2010;81(9):1119-1120
See related article on pelvic organ prolapse
What is pelvic organ prolapse?
Prolapse is when organs in your pelvis, such as the uterus, vagina, or bladder, protrude or sag through the opening of your vagina. It may feel like a bulge or a pouch.
How do I know if I have it?
Most women do not know that they have a prolapse. Your doctor may examine your pelvis with you lying down or standing up. To help diagnose prolapse, your doctor may ask you to strain (i.e., push as if you're trying to pass urine or stool).
What causes it?
There are many possible causes. You can lose strength in your pelvic muscles after giving birth (though prolapse usually occurs many years later). Getting older can lower your levels of the hormone estrogen, which increases your risk. Coughing a lot, being constipated, or having a hysterectomy can also cause prolapse.
How can I prevent it?
Stay at a healthy weight. Avoid constipation and chronic coughing. Use of hormone therapy for menopause symptoms may help.
What are my treatment options?
If the prolapse is mild or is not causing any problems with passing urine or stool, you probably won't need treatment. If you have problems going to the bathroom or if the prolapse is severe, a pessary (PESS-uh-ree) may help. A pessary is a rubber device that you place in the vagina to keep the uterus, vagina, or bladder from falling down or out of the vagina.
Doing pelvic muscle training or Kegel (KEE-gul) exercises may help if you have incontinence. This is when you lose urine if you cough or sneeze, or if you are not able to make it to the bathroom after you have the urge to pass urine. Other options include surgery.
What should I know about pessaries?
They can be used for mild, moderate, or severe prolapse. There are different types and sizes of pessaries. Depending on your problem, your doctor will fit you with the pessary that is most comfortable and works well when you are standing, sitting, walking, and using the toilet. You will need one follow-up visit in one to two weeks so the doctor can make sure the pessary is working and answer your questions. Your doctor will tell you when to schedule another visit.
You can take out your pessary, wash it with soap and water, and reinsert it yourself. Some pessaries may need to be removed and washed once every few weeks. Your doctor may prescribe a cream to apply to your vagina to prevent or treat vaginal discharge.
Most pessaries can be worn during sex. Tell your doctor if you have any bad smelling discharge, problems passing urine or stool, or any change in your ability to take care of the pessary (for instance, if you have a stroke or arthritis).
What are Kegel exercises?
They are exercises to strengthen the muscles of the pelvis. Your doctor can teach you how to do them. These exercises may help when you have symptoms of losing your urine when you do not expect it. You can do these exercises anywhere or anytime, such as when you are watching TV, driving, cooking, or lying in bed. You will squeeze the muscles of the pelvis as if trying to stop passing urine for 10 seconds and then rest for 10 seconds; you do this about 10 to 20 times a day. You may be given a set of Kegel cones to help you do the exercises.
Where can I get more information?
Your doctor
American Academy of Family Physicians
