Pelvic Organ Prolapse

Pelvic organ prolapse happens when the support muscles and tissues in your pelvis weaken and one or more organs begin to drop and bulge into the vagina. This can cause pressure, a heavy feeling, and sometimes trouble with bladder or bowel function.

At Riverstone Urology Specialists in Cypress, Dr. Russell Libby evaluates pelvic organ prolapse with a simple goal. Reduce symptoms, protect bladder and bowel function, and help you feel more comfortable and confident in daily life.

What Is Pelvic Organ Prolapse?

Your pelvic floor is a group of muscles and connective tissues that supports the bladder, uterus, vagina, and rectum from underneath. When these supports stretch or tear, one or more organs can drop from their usual position and push into the vaginal walls.

Common Types Include

Bladder prolapse, cystocele: The bladder bulges into the front wall of the vagina.
Uterine or vaginal apex prolapse: The uterus drops down, or the top of the vagina sags after hysterectomy.
Rectocele: The rectum bulges into the back wall of the vagina.

Many women have more than one type at the same time.

Pelvic organ prolapse is very common, especially in women who have had vaginal births and in women after menopause.

Symptoms

Some Women Feel Nothing. Others Have Symptoms That Affect Almost Every Part Of The Day. Typical Symptoms Include

A feeling of pressure, fullness, or heaviness in the pelvis or vagina
A bulge or tissue at the opening of the vagina that you can see or feel
A feeling that you are sitting on a small ball or that something is “falling out”
Need to push on the vagina or perineum to start or finish urination or bowel movements
Trouble starting urine or feeling that the bladder does not empty completely
Leaking urine with cough or activity, or strong urgency to urinate
Constipation or difficulty passing stool
Discomfort or pain with sexual intercourse

Symptoms often get worse as the day goes on, during standing, lifting, coughing, or straining. They usually ease when you lie down.

Common Causes And Risk Factors

Pelvic organ prolapse develops slowly over time. Often more than one factor plays a part.

Major Contributors Include

Pregnancy and vaginal childbirth, especially multiple deliveries or forceps use
Menopause and loss of estrogen support
Aging and general weakening of connective tissue
Obesity and long term heavy lifting
Chronic constipation and straining
Chronic cough from lung disease or smoking
Prior pelvic surgery such as hysterectomy
Family history of prolapse or connective tissue weakness

You did not cause prolapse by accident. It reflects years of stress on the pelvic floor combined with tissue changes that you cannot control.

When To See Dr. Libby

You Should Schedule A Visit If You

Feel a bulge at or beyond the vaginal opening
Have pelvic pressure that affects walking, work, or exercise
Have trouble emptying your bladder or bowels
Leak urine with cough, laugh, or urgency
Avoid intimacy because of pain, dryness, or embarrassment
Have already been told you have prolapse and your symptoms are getting worse

Guidelines suggest treatment when prolapse causes bothersome bulge, pressure, or problems with bladder, bowel, or sexual function.

If you feel symptoms are “bothersome,” that is enough reason to ask for help.

How Pelvic Organ Prolapse Is Evaluated

Evaluation Is Straightforward And Usually Completed In A Single Visit.

Additional Tests When Needed

Depending on your symptoms, testing may include

Urinalysis to look for infection or blood
Post void residual measurement to see how well you empty the bladder
Urodynamic testing if bladder function is complex or surgery is planned
Pelvic ultrasound or MRI in selected cases

Pelvic Exam

During a gentle pelvic exam, often with you bearing down or coughing, Dr. Libby looks for

Location and degree of prolapse in the front, top, and back of the vagina
Any skin irritation or ulceration
Signs of pelvic floor muscle weakness or over tightness

This exam also checks for conditions that often travel with prolapse, such as stress urinary incontinence.

Imaging When Needed

For some men, Dr. Libby orders a prostate MRI to look for suspicious areas and to help guide biopsy if needed.

The goal is to understand which organs are involved, how severe the prolapse is, and how it affects bladder and bowel function.

Treatment Options At Riverstone Urology

Not Every Woman With Prolapse Needs Surgery. Treatment Is Based On Symptom Severity, Your Health, And Your Personal Goals. Standard Options Include Observation, Pelvic Floor Therapy, Pessaries, And Surgery.

Observation And Lifestyle Changes

If symptoms are mild, you may choose simple measures such as

Weight loss if you are overweight
Treating chronic cough and avoiding tobacco
Managing constipation with fiber, fluids, and stool softeners
Avoiding heavy lifting when possible

Regular follow up checks that prolapse is not progressing in a way that concerns you.

Pelvic Floor Physical Therapy

Pelvic floor muscle training improves support in many women, especially those with early prolapse and mild to moderate symptoms.

A pelvic floor therapist can help you

Learn correct Kegel technique
Coordinate breathing with muscle work
Reduce harmful habits such as constant straining

This approach is low risk and works well combined with lifestyle changes.

Pessary Support

A vaginal pessary is a soft device placed inside the vagina that supports the vaginal walls and helps hold organs in place.

Pessaries are useful when you

Want to avoid or delay surgery
Are not a good candidate for surgery because of other health problems
Want a reversible option while you decide about long term plans

At the office, Dr. Libby will

Fit the pessary to your anatomy
Show you how it feels during standing and walking
Teach you how to remove and clean it, or schedule visits for cleaning if self care is not comfortable for you

Surgical Repair

If symptoms are strong or conservative care does not give enough relief, surgery becomes a reasonable option. Surgical repair aims to restore support, correct the bulge, and protect bladder and bowel function.

Depending on which organs are involved and whether you wish to keep the uterus, surgery may include

Repair of the front or back vaginal wall to support bladder or rectum
Suspension of the uterus or vaginal apex to strong ligaments
Combined procedures that address prolapse and stress incontinence at the same time

Most repairs use your own tissues. Mesh use in the vagina has specific risks and is handled very carefully under current guidelines. For many women, native tissue repairs offer good results and avoid mesh.

Dr. Libby will explain

What the operation does and does not do
Expected recovery time
Activity limits after surgery
Realistic expectations for symptom relief and recurrence risk

You and Dr. Libby decide together whether surgery fits your life and goals.