By Susan White

Pelvic prolapse—when the connective tissues and muscles supporting the bladder, uterus and vagina weaken and no longer provide enough support so organs begin to move down into the vagina—is quite common though often not discussed even by women who may be bothered by symptoms.

The most common symptom is a feeling of pelvic pressure or a vaginal bulge; prolapse typically does not cause pain.

“It’s important to understand that prolapse is not dangerous or life-threatening, and only needs to be treated if it’s affecting your quality of life and day to day activities,” explained Sonia Dutta, MD, NorthShore Urogynecology, fellowship-trained surgeon and expert in female pelvic medicine and reconstructive surgery.

Among the known risk factors for pelvic prolapse are pregnancy; vaginal delivery especially those assisted with vacuum or forceps; genetics; excess weight; chronic constipation; chronic coughing and regular heavy lifting.

Some women are not even aware that they have pelvic prolapse until their gynecologist mentions it at an exam. “Patients can get flustered or worried once they hear a doctor mention it, but they really don’t have to do anything about it unless it’s bothering them,” added Dr. Dutta.

Many women with prolapse will also experience stress incontinence, or leakage with coughs and sneezing, as well as a change in urination.

For patients who are bothered by prolapse symptoms there are several treatment options, beginning with the most conservative approach of pelvic floor physical therapy. While physical therapy will not eliminate the bulge, strengthening the muscles around it may decrease the sensation of a bulge, heaviness or pressure, explained Dr. Dutta.

Another treatment option is a vaginal support device, known as a pessary, that is inserted into the vagina and helps hold organs in place. Pessaries are individually fitted in a physician’s office and ideally patients learn how to remove it and place it on their own. “We know there is power in that sense of control,” said Dr. Dutta.

And when the more conservative therapies are not enough, reconstructive surgery is a viable option. There are multiple surgical options including using a surgical mesh to help provide a stronger scaffolding for organs. While procedures involving mesh attracted negative attention several years ago and a specific product was removed from the market by the FDA, it is a safe and effective option today, explained Dr. Dutta.

“Women considering surgery should look for fellowship-trained surgeons who do significant volumes of cases,” said Dr. Dutta. “We do so many of these procedures we know what to look for and how to prevent potential complications.”

She urged women to take the time to consider all their options and understand that they do not have to rush to any treatment.

Visit NorthShore’s Center for Pelvic Health for more information on pelvic health disorders or to schedule an appointment with a urogynecologist.