Pelvic organ prolapse occurs when the ligaments and muscles that support the pelvis weaken or stretch, causing one or more pelvic organs or structures to drop out of position, or prolapse, and press against the vagina. At NYU Langone, our doctors diagnose and treat prolapse of the affected organs, which may include the bladder, bowel, rectum, urethra, and uterus. The upper portion of the vagina can also prolapse into the lower vaginal canal, or outside of the vagina, particularly in women who have had the uterus removed. This is referred to as vaginal vault prolapse and can also be treated by doctors at NYU Langone.
The pelvic muscles and supporting structures can weaken due to a variety of reasons. This may be the result of childbirth, a prior pelvic surgery such as hysterectomy, straining caused by frequent constipation or chronic cough, and obesity, which puts added pressure on the pelvis.
Many women experience pelvic organ prolapse at some point in their lives, but the condition isn’t always severe enough to cause symptoms. Some women feel pressure or a bulging sensation in the lower pelvis, or they may feel like something is falling out of the vagina. Other symptoms include pain during sex, urinary leakage, constipation, vaginal spotting or irregular bleeding, and backache.
Pelvic organ prolapse affects women of all ages, but it’s more common in women 40 to 60 years old.
To diagnose pelvic organ prolapse, an NYU Langone doctor takes a medical history and performs a routine pelvic exam. He or she may then repeat the pelvic exam while you’re standing. Sometimes this is all that’s needed to determine if an organ has fallen out of place, and, if so, which one. Other tests may be done to determine if more than one organ has slipped out of place, to assess the degree of the prolapse, and to check for urinary conditions, such as incontinence, that can be caused by prolapse.
If your symptoms indicate that more than one organ has shifted out of place, your doctor may order an ultrasound exam, in which sound waves are used to create images of the pelvis. Ultrasound also helps your doctor to determine the degree of the prolapse. It can be performed at the Center for Female Pelvic Medicine and doesn’t require any preparation.
Your doctor may order a dynamic pelvic MRI scan, which uses magnetic waves to create images of the pelvis, to confirm the diagnosis and determine the extent of the prolapse. Dynamic pelvic MRI allows doctors to see detailed, three-dimensional images of the organs and pelvic floor muscles, which can help them to decide if surgery is needed. You are not exposed to radiation during an MRI scan.
Your doctor may recommend a cystoscopy, which allows him or her to view the inside of the bladder using an endoscope to evaluate symptoms such as bladder pain and the frequent urge to urinate. The endoscope, a thin tube with a small light and camera at the tip, is inserted into the urethral opening. Your doctor then glides the endoscope through the urethra—the tube that carries urine out of the body—to the bladder. This procedure is performed using local anesthesia and takes place in the doctor’s office.
If the prolapse is causing incontinence, which is the involuntary leaking of urine, urodynamic tests may be used to determine the cause. These can include tests that measure urine speed and volume, the amount of urine left in the bladder after urination, how much urine the bladder can hold, and bladder pressure. Sometimes, a cystourethrogram, in which X-rays are taken to provide your doctor with pictures of the bladder and urethra before and during urination, is used to look for causes of incontinence or problems with the bladder and urethra.
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