Pelvic Organ Prolapse

Integrated Clinical Care to Diagnose and Treat Pelvic Organ Prolapse

Loyola Medicine takes an integrated, multidisciplinary approach to the diagnosis and treatment of pelvic organ prolapse. Far too many women needlessly suffer in silence, keeping symptoms to themselves and going years without receiving proper treatment. 

Loyola’s team of highly experienced specialists will evaluate your symptoms, provide you with the correct diagnosis and develop an individualized treatment plan to help you to enjoy a more functional life again.

Loyola’s specialists have experience treating the many types of pelvic organ prolapse, including:

• Cystocele
• Enterocele
• Rectocele
• Uterine prolapse
• Vaginal vault prolapse

Why Choose Loyola for Pelvic Organ Prolapse?

Loyola provides truly integrated clinical care for pelvic organ prolapse, bringing together specialists in gynecology, gynecologic surgery and female pelvic medicine and reconstructive surgery to provide women with advanced care in a compassionate environment.

As part of an academic medical center, Loyola’s expert clinicians perform and teach the latest surgical techniques and medical treatments in numerous locations across the Chicago area. Our doctors and advanced practice nurses provide preventive care for women of all ages, from young girls to menopausal women. In addition, our nurses have earned Magnet status, which means they have been recognized for delivering the highest level of care.

Your Loyola doctor will first explore non-surgical treatments to address your condition. However, if surgery is deemed the best treatment option, we perform the vast majority of procedures via laparoscopy, surgeon-guided robotic surgery or vaginally.

These approaches are known to reduce pain, scarring and recovery time. Loyola was one of the first medical centers in the Chicago area to offer minimally invasive gynecologic surgery.

In addition, Loyola offers a chronic pelvic pain program that is made up of an all-female team of medical and surgical experts, as well as specialized pelvic floor physical therapists, forming one of the first programs of its kind in the United States.

This team was founded by an all-female group of doctors, surgeons and advanced practice nurses, some of whom have been providing women’s healthcare for more than 30 years.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse is a common condition that occurs in women when the vaginal wall starts to bulge outside of the vagina, or the rectum starts to protrude outside of the anus. Usually a woman will start to feel a bulge that is soft and can be pushed back in place with her fingers. Other symptoms of pelvic organ prolapse include:

• Bladder pain
• Constipation
• Fecal incontinence
• Frequent urinary tract infections
• The sensation that something is coming out of the anus or vagina
• Urinary frequency
• Urinary incontinence
• Vaginal or pelvic pressure or aching

Pelvic organ prolapse is caused by a weakening in the pelvic floor muscles and connective tissues that support the uterus and vagina.

As the vaginal walls weaken, other organs that are in close proximity—such as the bladder, uterus, rectum and small bowel—may be affected. Vaginal childbirth may cause the initial injury to the pelvic floor muscles, resulting in pelvic floor weakening, that can show up as prolapse later in life.

Initially, few women have symptoms, but as the prolapse grows, it can become more noticeable. Other factors that have been linked to pelvic organ prolapse are:

• Chronic constipation
• Chronic cough conditions
• Family history of the condition
• Heavy lifting
• Obesity
• Pelvic organ cancers
• Respiratory problems
• Smoking

Loyola’s specialists have experience treating the many types of pelvic organ prolapse, including:

• Cystocele (anterior vaginal wall prolapse) — This condition occurs when the tissues that support the front of the vaginal wall and the top of the vagina and uterus weaken, allowing the front of the vaginal wall to descend and affect the bladder. Cystocele may cause discomfort and problems with emptying the bladder, but there may be no symptoms other than a bulge. This condition can often be managed with non-surgical treatment, with surgical options available. 
   
• Enterocele (vaginal vault prolapse) — This condition occurs most often in women who have had a hysterectomy. The small bowel descends into the lower pelvic cavity, pushing at the top part of the vagina and causing the vaginal wall to protrude. This condition can be managed non-surgically as well as surgically. 
   
• Rectal prolapse — This condition occurs when the rectum loses its normal attachments within the pelvic area and bulges into the anus. Initially this may occur only during bowel movements, but in later stages this can happen while standing or walking. 
   
• Rectocele (posterior vaginal wall prolapse) — This condition occurs when the tissues that support the posterior vaginal wall and the top of the vagina and uterus weaken, allowing the posterior vaginal wall to protrude beyond the vaginal opening. Non-surgical treatment methods are often effective in treating this condition. 
   
• Uterine prolapse — This condition occurs when the tissues that support the uterus and top of the vaginal wall weaken, allowing the vagina to turn inside out and protrude. Some uterine prolapse can be normal after a woman has a vaginal delivery. As this condition worsens, the front and back of the vaginal wall along with the uterus can become affected. A bulge that can be felt outside of the vagina usually can be a sign that the condition needs to be evaluated.

How is Pelvic Organ Prolapse Diagnosed?

Your Loyola doctor first will take a complete medical and family history, including all surgeries, and then conduct a pelvic exam. Your doctor may ask you to stand and bear down, as during childbirth or a bowel movement, which allows for the best assessment of this condition. Prolapse also may be discovered during a routine pelvic exam as part of your regular medical checkup.

Radiological and lab tests are not often used to make this diagnosis, but may be used to understand your condition more fully. These tests and procedures may include:

• Bladder function test — This test measures your bladder's ability to store and empty urine. 
   
• Cystoscopy — Using a tube with a light and a camera, your doctor can evaluate urinary symptoms and anatomical abnormalities of the urethra and bladder. 
   
• Defecography — This study is used to evaluate prolapse symptoms associated with bowel function. 
   
• Pelvic floor MRI (magnetic resonance imaging) — Your doctor may request an MRI of your pelvic floor in order to evaluate function of the muscles, organs and support of the pelvic floor. 
   
• Pelvic floor strength tests — These tests are used to measure the strength of your pelvic floor and sphincter muscles, as well as the muscles and ligaments that support the vaginal walls, uterus, rectum, urethra and bladder. 
   
• Pelvic ultrasound — A pelvic ultrasound provides imaging of your reproductive organs, bladder, kidneys and pelvic floor muscles. 
   
• Urodynamics — This study is used to determine how well the bladder, sphincters and urethra are storing and releasing urine.

How is Pelvic Organ Prolapse Treated?

Loyola’s female pelvic medicine and reconstructive surgeons and gynecologists specialize in the diagnosis, treatment and management of pelvic organ prolapse. Our clinicians have received specialized training to diagnose complex conditions and provide the most advanced treatment options.

Treatment for pelvic organ prolapse depends on the severity of your symptoms and how these symptoms interfere with your daily activities and quality of life, and may include:

• Pelvic floor physical therapy — Loyola’s program works in conjunction with our chronic pelvic pain program, which was one of the first such programs in the United States. Our all-female team utilizes advanced techniques to provide relief for many treatment-resistant conditions. Our team is trained in pelvic health and may use hands-on techniques to release trigger points and re-educate muscles affected by pelvic and nerve pain. Loyola’s physical therapists are skilled in evaluating and treating dysfunction in the joints, muscles, nerves and scar tissue. These treatments can help strengthen pelvic muscles, which may reduce pelvic and bladder pain, bladder spasms, leakage and the sudden urge to urinate. Learn more about pelvic floor physical therapy. 
   
• Urogynecologic and reconstructive pelvic surgery — Loyola offers a single site for the multidisciplinary diagnosis and treatment of pelvic floor dysfunction for women. Various surgical procedures are available to correct pelvic organ prolapse. Our team was the first to use minimally invasive approaches, such as laparoscopic surgery and physician-guided robotic surgery, to repair pelvic organ prolapse. You and your doctor will consider your activity level, age, health and desire for sexual activity in determining the best surgical approach. Learn more about urogynecologic and reconstructive pelvic surgery. 
   
• Pessaries — These devices can help control symptoms of pelvic organ prolapse and urinary incontinence. 
   
• Incontinence treatment — Our team offers various treatments for urinary incontinence and fecal incontinence, which may be brought on by pelvic organ prolapse.

Ongoing Research to Advance Treatment of Pelvic Organ Prolapse

Loyola’s expert clinicians are actively pursuing new research with a focus on patient-centered outcomes, including studies on:

• Aging and pelvic floor function
• Maximizing surgical outcomes
• Pelvic floor dysfunction
• Pessaries and their use

As an academic medical center, Loyola is dedicated to improving future treatments by conducting research on new diagnostics and treatments. Loyola’s patients benefit from research discoveries made here; read about Loyola’s current clinical trials.