Pelvic Organ Prolapse and Urinary Incontinence

The pelvic floor is a group of muscles and connective tissues that support the bladder, uterus, vagina, rectum, and other pelvic organs.

Pelvic Organ Prolapse
Pelvic organ prolapse occurs when the muscles and connective tissues supporting the pelvic organs become weakened or stretched. When these structures can no longer adequately support the organs, one or more pelvic organs may drop downward and press against the vagina.

Women often describe prolapse as:

• A feeling of pressure, heaviness, or fullness in the pelvis
• A sensation that something is falling or bulging from the vagina
• Feeling or seeing a bulge at the vaginal opening

Urinary Incontinence
Urinary incontinence is the loss of bladder control.

Common types include:

• Stress incontinence: Leakage of urine during activities that increase pressure on the bladder, such as coughing, laughing, sneezing, or exercise.
• Urge incontinence: Leakage that occurs when there is a sudden, strong urge to urinate and a person cannot reach the bathroom in time.

Pelvic organ prolapse and urinary incontinence frequently occur together and often share the same risk factors.

Some women have no symptoms at all. Others may experience:

• Pelvic pressure or heaviness
• A bulge or lump in the vagina
• Difficulty emptying the bladder completely
• Urinary frequency, urgency, or leakage
• Constipation or difficulty with bowel movements
• Pain or discomfort during intercourse

Several factors can increase the likelihood of developing pelvic organ prolapse and urinary incontinence:

• Pregnancy and vaginal childbirth
• Multiple pregnancies
• Long or difficult labor
• Delivering larger babies
• Aging
• Menopause and hormonal changes
• Family history or genetic predisposition
• Obesity or excess weight
• Chronic coughing
• Frequent constipation and straining
• Repetitive heavy lifting
• Smoking and other lifestyle factors that affect tissue health

Having one or more risk factors does not mean you will develop these conditions, but it may increase your risk.

Treatment depends on the type of condition, the severity of symptoms, and how much symptoms affect daily life. If symptoms are mild and not bothersome, treatment may not be necessary.

Conservative Treatments

For both pelvic organ prolapse and urinary incontinence, treatment may include:

• Pelvic floor exercises (Kegels)
• Pelvic floor physical therapy with specially trained therapists
• Weight management and lifestyle modifications
• Managing constipation and reducing straining
• Adjustments to fluid intake, diet, and toileting habits
• Medications for certain types of urinary incontinence

Pessary

A pessary is a removable device placed in the vagina to help support the pelvic organs. It is fitted in the office and can be an effective non-surgical option for many women.

Surgical Treatment

When symptoms are severe or conservative treatments do not provide adequate relief, surgery may be considered. Most prolapse surgeries are performed using minimally invasive techniques, often on an outpatient basis, allowing patients to return home the same day. Many women experience significant improvement within two weeks and complete recovery by about six weeks.

Surgical options for prolapse may include:

• Vaginal repairs using the patient’s own tissues and ligaments, with or without hysterectomy
• Laparoscopic or robotic-assisted repairs using native tissue
• Sacrocolpopexy, a minimally invasive procedure that uses permanent mesh to support the vagina
• Colpocleisis, a vaginal closure procedure reserved for women who are no longer sexually active

There are also surgical procedures for urinary incontinence depending on a patient’s symptoms, which can include bladder Botox, sacral nerve stimulation, urethral bulking injections, and mesh slings.

The right procedure depends on a woman’s symptoms, anatomy, health history, and personal goals. Shared decision-making with a urogynecologist is essential.

Many women silently live with symptoms because they believe pelvic floor disorders are simply a normal part of aging or childbirth. However, these conditions are not a normal part of aging, can significantly impact quality of life, and are often treatable.

If you notice:

• Pelvic pressure or heaviness
• A vaginal bulge
• Urinary leakage
• Difficulty with bladder or bowel function

Talk with your healthcare provider. Early evaluation and treatment can improve comfort, help maintain an active lifestyle, and enhance overall quality of life.

If you have symptoms of pelvic organ prolapse or urinary incontinence, speak with your Primary Care Provider or Gynecologist about a referral to Urogynecology.

Q: What is pelvic organ prolapse, and what causes it?

A. Pelvic organ prolapse occurs when pelvic organs such as the uterus, bladder, rectum, or vagina begin to sag because the muscles and tissues supporting them have weakened. Common risk factors include pregnancy and childbirth, aging and menopause, obesity, genetics, heavy lifting, and smoking.

Q: What are the different types of urinary incontinence?

A. Urinary incontinence is the loss of bladder control.

Two common types are:

• Stress incontinence: Urine leakage during activities such as coughing, laughing, sneezing, or exercise.
• Urge incontinence: Leakage that occurs when a sudden, strong urge to urinate makes it difficult to reach a bathroom in time.

Q: What treatment options are available for pelvic organ prolapse and urinary incontinence?

A. Treatment depends on the severity of symptoms and may include pelvic floor exercises, physical therapy, lifestyle changes, weight management, medications, pessaries (support devices placed in the vagina), or surgery. For some cases of prolapse that are not bothersome, no treatment may be necessary.