By: Dr. Howard Goldstein and  Dr. Babak Vakili

Most people have never heard of pelvic organ prolapse – the sagging or dropping of the bladder, uterus, vagina or rectum – yet half of women will develop this condition at some point in their life.

A complex group of muscles and ligaments supports the organs within the pelvis. When these tissues weaken or fail, the pelvic organs drop into the vagina, causing pelvic organ prolapse.

Prolapse is dependent on gravity pulling it down; women often describe worsening symptoms at the end of the day or during increased upright activity, while having relatively symptom-free periods in the morning. Others may not have any symptoms of their prolapse and are unaware they have this condition.

Pelvic organ prolapse results in the uterus, bladder, rectum or bowel dropping into or out of the vagina, leading to any one of a range of symptoms, including:
•    Fullness or pressure in the vagina.
•    Difficulty urinating or defecating.
•    Pain in the pelvis or lower back.
•    The feeling of sitting on something that is not supposed to be there.
•    Difficulties with intercourse.
•    Leaking of urine or stool.
•    Recurrent urinary tract infections.

Symptoms are dependent on which structures are involved; at times, more than one organ may drop into the vagina, complicating the situation even further.

Prolapse tends to result from a combination of multiple factors. Some of these causes include:
•    Childbirth.
•    Smoking.
•    Chronic cough.
•    Constipation.
•    Obesity.
•    Age.
•    Menopause.
•    Prior pelvic surgery.
•    Genetics.

Thankfully, this condition is not life threatening. Dangerous long term consequences of the condition are uncommon. However, prolapse does often affect a woman’s quality of life. The condition may impact everyday tasks like walking, exercise, sitting and standing.

Your physician will conduct a special type of pelvic exam to diagnose pelvic organ prolapse. The patient will strain during the exam while various walls of the vagina are isolated. At times, the physician may exam the patient in the standing position.

The exam will identify areas of weakness and determine the severity of prolapse. In addition to the physical exam, patients are asked to complete a questionnaire assessing to what degree the prolapse is affecting their quality of life. This questionnaire helps measure the success of any treatment.

Pelvic organ prolapse is a treatable condition, with a variety of options available to reverse the process and allow one to resume a normal life. If you feel you have pelvic organ prolapse, feel free to make an appointment at The Center for Urogynecology and Pelvic Surgery. The physicians are fellowship trained experts in the field of pelvic organ prolapse who can accurately diagnose and treat this condition. During the initial consultation, your physician will inform you of the type of prolapse you have as well as a myriad of treatment options available.

We will discuss these treatment options in upcoming issues of the Women’s Journal.

Howard B. Goldstein, D.O., MPH, is a fellow of the American College of Obstetrics and Gynecology. He completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery at Cooper University Hospital in Camden, N.J. He currently serves as the Director of Research and Education for the Division of Urogynecology.
Babak Vakili, M.D. is the director of the Center for Urogynecology and Pelvic Surgery. Dr. Vakili is a fellow of the American College of Obstetrics and Gynecology. He completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery at the Louisiana State University Health Science Center in New Orleans, LA.

The Christiana Care Center for Urogynecology and Pelvic Surgery is located in Suite 1208 of Medical Arts Pavilion 2, on the campus of Christiana Hospital in Newark. Appointments are also available at the Christiana Care Center for Women’s Health, 3706 Kennett Pike in Greenville. To schedule an appontment, call 302-623-4055.