Is Pelvic Organ Prolapse Common?

One of the most common conditions we see at Austin Urogynecology is pelvic organ prolapse. Pelvic organ prolapse (POP) is the result of a relaxation of the pelvic supportive fascia and muscles that work to hold the bladder, uterus and rectum in place. Incidence of pelvic organ prolapse is fairly common and increases with age and an increase in overall risk factors. The most common causes of POP are age, genetics and vaginal deliveries. Women with prolapse and no prior vaginal deliveries often have a genetic predisposition to develop prolapse (their mom or grandmother likely had prolapse as well). A cystocele is a relaxation of the bladder, allowing the bladder to drop into the vagina out of its normal position. Women with cystocele often notice a bulge in the vagina with associated irritative or obstructive voiding complaints or pelvic pressure. A rectocele is a relaxation of the supportive tissue that holds the rectum in place, allowing the rectum to bulge into the vagina. This too can result in symptoms of a vaginal bulge, or pelvic pressure or heaviness. Women with a rectocele may also complain of worsening constipation or a sense of incomplete defecation (poor emptying with bowel movements). This may be accompanied by perineal relaxation, in which the perineum also bulges downward, especially with straining or bowel movements. Uterine prolapse occurs when the uterus descends downward from the abdomen into the vagina. In cases of advanced uterine prolapse, the cervix and uterus may protrude outside of the vaginal opening. Women with uterine prolapse often complain of low back pain and pelvic pressure in addition to vaginal bulge symptoms. For advanced uterine prolapse in women who are post-menopausal or are not seeking future pregnancies, a hysterectomy may be recommended. This is often done in conjunction with prolapse repair. The type of repair recommended is based on each individual patient’s symptoms, her exam and her desired outcome. At Austin Urogynecology, we work closely with our patients to develop the optimal treatment plan which may include vaginal prolapse repair or da Vinci sacrocolpopexy.