An Overview of Pelvic Organ Prolapse With Dr. D’Abarno

If you’re experiencing urinary difficulties, pressure, bulging or similar symptoms, you may have pelvic organ prolapse. It’s estimated that up to 50% of women ages 50 and older are affected by this condition, according to the American Urogynecologic Society. Fortunately, treatments and technologies continue to advance, offering you minimally invasive treatment options to restore function and comfort.

Keep reading to learn more about pelvic organ prolapse from gynecologist Dr. Jennifer D’Abarno, including the types, symptoms, risk factors, available treatment methods and your road to recovery.

What Is Pelvic Organ Prolapse

“Pelvic organ prolapse is a condition that occurs when one or more of the pelvic organs drop from their normal position,” says Dr. D’Abarno. “When this happens, a bulge is formed in the vagina, called a prolapse.”

Dr. D’Abarno explained that the muscles and connective tissues of the pelvic floor typically hold the pelvic organs in place. These organs include the vagina, bladder, uterus, urethra and rectum. But when the muscles and tissues of the pelvic floor weaken, a prolapse may occur. “The type of prolapse that develops depends on where the weakness in the pelvic floor is and what organs become affected,” explained Dr. D’Abarno. The different types of pelvic organ prolapse include:

• Anterior vaginal wall prolapse (cystocele): weakened vaginal muscles allow the bladder to move out of its normal position, creating a bulge in the vagina
• Enterocele: weakened pelvic floor muscles allow the small intestine to bulge into the back wall or the top of the vaginal area
• Posterior vaginal wall prolapse (rectocele): weakened pelvic floor muscles between the vagina and rectum allow the rectum to bulge into the back wall of the vagina
• Urethrocele: weakened pelvic floor muscles allow the urethra to drop, usually accompanied by a dropped bladder
• Uterine prolapse: weakened pelvic floor muscles allow the uterus to drop into the vaginal canal
• Vaginal vault prolapse: the top part of the vagina, known as the vaginal vault, drops into the vaginal canal

The first step toward pelvic health is understanding the symptoms and risk factors of pelvic organ prolapse.

Prolapse Symptoms and Risk Factors

While the symptoms of pelvic organ prolapse vary by type, they generally share common features. Symptoms include:

• A bulge in the vagina
• Difficulty passing stool
• Fecal incontinence
• Painful intercourse
• Pelvic pressure
• Urinary difficulties, like incontinence

Common risk factors for developing pelvic organ prolapse include:

• Connective tissue diseases: People with conditions like Ehlers-Danlos syndrome, Marfan syndrome and joint hypermobility syndrome are at risk of pelvic organ prolapse.
• Family history: Research into the genetic components of pelvic organ prolapse is ongoing, but pelvic floor weakness may have an inherited component.
• Having a heavier body weight: Studies have shown that people who are overweight or obese are more likely to develop pelvic organ prolapse, and people who are within a weight range that is healthy for them are less likely to develop it.
• Long-term pressure in the abdominal cavity: Chronic pressure on the pelvic floor muscles can weaken them. Examples such as chronic constipation, chronic coughing and frequent heavy lifting all increase the chance of developing pelvic organ prolapse.
• Prior pelvic floor surgery: Prior surgeries, including a hysterectomy, can lead to pelvic floor weakness.
• The aging process: Muscles lose strength with age. One factor is declining estrogen levels. During menopause, your body produces less and eventually no significant estrogen. The decline can weaken the connective tissues that support the pelvic floor.
• Vaginal childbirth: This is the most common cause of prolapse. Multiple vaginal deliveries, having twins or triplets, having a large baby, fetal macrosomia and having a delivery with forceps or a vacuum all increase the odds of pelvic floor muscles weakening.

While knowing the signs, symptoms and risk factors associated with pelvic organ prolapse is important, we also need a clear understanding of how common it is.

How Common Is Pelvic Organ Prolapse?

“Pelvic organ prolapse is remarkably common,” shared Dr. D’Abarno. “Estimates of lifetime risk range from 30% to 50% when counting any degree of anatomical change, though only 3% to 12% of women experience symptoms they actually notice.”

Dr. D’Abarno went on to explain that the gap between what a doctor might see on an exam and what a woman feels is one of the most important things to understand about this condition. About 37% of women with pelvic floor disorders, including pelvic organ prolapse, are between the ages of 60 and 79, and over half are 80 or older. Although this condition is common, there are many ways we can treat it.

Treating Pelvic Organ Prolapse

When it comes to treating pelvic organ prolapse, our providers can take either a surgical or nonsurgical approach. While our gynecologists hope to treat your condition nonsurgically, some cases require surgery.

Nonsurgical Approaches

“Strengthening the pelvic floor muscles through techniques like Kegel exercises can help manage mild cases of prolapse,” stated Dr. D’Abarno. “These exercises involve tightening and relaxing the pelvic muscles to improve support for the pelvic organs. This can be done through formal pelvic floor physical therapy, but there are now devices available online to assist with Kegel exercises and biofeedback.”

Other nonsurgical approaches include:

• Hormonal treatments: For many postmenopausal women, estrogen therapy may help strengthen vaginal tissues and improve some symptoms, although it's not suitable for everyone. Hormonal treatments have a limited role in treating significant prolapse.
• Lifestyle modifications: Changes such as maintaining a healthy weight, avoiding heavy lifting and increasing fiber intake to prevent constipation can all help alleviate symptoms associated with prolapse.
• Pessaries: A pessary is a silicone or rubber device that is inserted into the vagina to support the prolapsed organs. A healthcare provider can fit it and must clean it periodically. Pessaries are a good option for women who wish to avoid surgery. They come in different sizes and styles.

Surgical Approaches

There are several surgical approaches your provider may use to treat pelvic organ prolapse. Surgical options include:

• Hysteropexy: For women with uterine prolapse desiring to preserve their uterus or have a quicker recovery, hysteropexy, which involves the suspension of the uterus itself to ligaments in the pelvic floor, is another option.
• Reconstructive surgery: Surgery aims to restore the normal position of the pelvic organs. It may or may not involve a hysterectomy in addition to other vaginal repairs. Examples include anterior and posterior colporrhaphy, in which the vaginal walls are repaired to support the bladder or rectum. The vaginal approaches are generally the preferred approach, but laparoscopic and robotic approaches are also available and tend to involve the use of mesh to suspend the vagina or uterus.
• Sling procedures: For women experiencing stress urinary incontinence along with prolapse, surgical options like a bladder neck suspension with a sling procedure may be performed to support the urethra.
• Vaginal vault suspension: Similarly, women with vaginal vault prolapse after a previous hysterectomy may desire a simpler form of vaginal vault suspension that doesn’t require complete reconstruction of the vaginal cavity. This allows for a shorter procedure and quicker recovery.

There’s also a minimally invasive surgical approach known as the EnPlace procedure.

“The EnPlace procedure is a minimally invasive, same-day surgical approach to repair pelvic organ prolapse by anchoring pelvic tissues without mesh or extensive dissection,” shared Dr. D'Abarno. "This procedure is designed to restore and support weakened pelvic floor tissues in women experiencing pelvic organ prolapse or stress urinary incontinence."

Dr. D'Abarno explained that the EnPlace procedure uses a small, low-profile device to anchor and reposition tissues, lifting pelvic organs back into place without large incisions or mesh. The procedure typically takes about 30 minutes, significantly shorter than traditional approaches that can last 75 to 120 minutes.

Benefits of EnPlace

The EnPlace procedure offers many benefits, including:

• A quick recovery time
• Outpatient, same-day procedure
• Minimal downtime
• Little to no scarring
• Preservation of the uterus
• Proven safety and effectiveness
• Suitable for older adults
• Avoids using a mesh and extensive surgery
• Easily tailors to patients’ goals

This procedure offers a fast, safe and effective alternative to traditional pelvic organ prolapse surgery with many patient benefits, making it a valuable option for many women seeking to restore pelvic health without long-term restrictions," explained Dr. D'Abarno.

Success Rate and Recovery

Dr. D'Abarno told us that clinical studies show very low recurrence rates — around 2 to 6.7%, compared with 20 to 30% for traditional surgeries — and minimal complications. Patient satisfaction exceeds 90% in some studies.

Most patients can resume normal daily activities, including light exercise and work, within two to three days. Sexual activity can resume at four to six weeks. This is significantly faster than traditional prolapse surgeries, which often require weeks or months of recovery.

Helping Women Reclaim Their Health

When it comes to your pelvic health, you deserve exceptional care and the utmost compassion. That’s why our team of gynecologists is committed to working with you and a multidisciplinary team of experts to help you reclaim your health and confidence.

Request an appointment with Dr. D’Abarno for a consultation or to learn more about your treatment options.