As you age, it is quite common to experience relaxation of the support of your bladder, vagina, uterus or rectum, especially if you have had children by vaginal delivery. This can be normal, but if it becomes bothersome it may cause a sense of pressure or bulging in your vaginal area. Sometimes you can even feel or see a bulge outside of your vagina. Treatment can eliminate symptoms and restore enjoyment of daily activities.

Types of pelvic prolapse include

We provide surgical and non-surgical treatments for these conditions.

Cystocele

Loss of support for your bladder, known as a cystocele may contribute to urinary leakage, difficulty in starting your urine flow or even trouble emptying your bladder.

Rectocele

A rectocele occurs when your rectum presses into the space of your vagina and can cause similar symptoms of difficulty starting or completing a bowel movement.

Uterine or vaginal prolapse

If you have had a hysterectomy, can affect your bowel or bladder function or simply cause sensations of pressure.

Pessaries

A vaginal pessary is a removable device placed into the vagina to support areas of pelvic organ prolapse. Pessaries come in different sizes and may be made of rubber, plastic, or silicone-based material. There are many circumstances where we recommend pessaries including patients who have temporary prolapse symptoms due to pregnancy. We can discuss types of pessaries and make sure yours fits, offers relief and stays in position without causing discomfort.

Medications for pelvic prolapse

Menopause results in lower estrogen levels, which weakens the tissues of the vagina. Estrogen therapy may improve the tissues. However, some people shouldn't use estrogen, so discuss risks and benefits with your doctor.

Physical therapy for pelvic prolapse

Physical therapy may include pelvic floor exercises using biofeedback to strengthen specific muscles of the pelvic floor. Biofeedback involves the use of monitoring devices with sensors that are placed in your vagina, rectum or on your skin. As you perform an exercise, a computer screen shows whether you're using the right muscles and the strength of each squeeze (contraction) so you learn how to do the exercises properly.

Surgical treatments for pelvic prolapse, cystocele and rectocele

Surgical treatment for your condition will depend on your specific type of pelvic organ displacement as well as your age, activity level and overall health. If multiple conditions are occurring simultaneously, we try to correct all prolapse-related problems at one time. We don’t recommend surgery for all patients.

Our surgeons have extensive experience and frequently use minimally invasive (laparoscopic) surgery, including robot-assisted surgery, to treat some types of pelvic organ prolapse. Minimally invasive surgery allows your surgeon to make smaller incisions and can shorten your hospital stay.

OHSU’s urogynecology team is actively researching ways to improve the treatment of pelvic organ prolapse. You benefit from this important research, and your treatment contributes to future knowledge.