Question 1

What is pelvic organ prolapse?

Accepted Answer

Pelvic organ prolapse occurs when the pelvic floor muscles and supporting ligaments weaken and can no longer hold the pelvic organs in their normal position. This allows organs such as the bladder (cystocele), uterus (uterine prolapse), rectum (rectocele), or vaginal apex to shift downward into the vaginal canal.

Question 2

What causes pelvic organ prolapse?

Accepted Answer

Pelvic organ prolapse is most commonly caused by factors that strain or weaken the pelvic floor, including:

• Vaginal childbirth
 • Aging
 • Menopause
 • Decreased estrogen levels
 • Chronic constipation or straining
 • Heavy lifting
 • Obesity
 • Prior pelvic surgery
 • Genetic connective tissue weakness

Question 3

What are the symptoms of pelvic organ prolapse?

Accepted Answer

Symptoms may include vaginal pressure or fullness, a visible or palpable bulge, pelvic discomfort, difficulty emptying the bladder or bowels, urinary leakage or urgency, pain during intercourse, or symptoms that worsen with prolonged standing.

Question 4

How is pelvic organ prolapse diagnosed?

Accepted Answer

Diagnosis is made through a detailed medical history and pelvic examination to assess pelvic floor strength and organ support. Imaging is rarely required but may be used in select cases.

Question 5

What are the treatment options for pelvic organ prolapse?

Accepted Answer

Treatment for pelvic organ prolapse depends on the type and severity of prolapse, the symptoms you are experiencing, and your personal goals. Many women do not require surgery and can successfully manage prolapse with conservative therapies. Treatment options may include:

• Lifestyle modifications
 • Pelvic floor physical therapy
 • Emsella chair treatment
 • Vaginal estrogen therapy
 • Pessary fitting and management
 • Minimally invasive surgical repair
 • Reconstructive pelvic surgery

Not all pelvic organ prolapse progresses, and early treatment can often reduce symptoms, improve pelvic floor strength, and prevent worsening over time. We work closely with each patient to develop an individualized treatment plan that prioritizes function, comfort, and long-term pelvic health.

Question 6

Can pelvic organ prolapse be treated without surgery?

Accepted Answer

Yes. Many women pelvic organ prolapse can be successfully treated without surgery, especially when prolapse is mild to moderate or symptoms are manageable. Non-surgical treatment focuses on improving pelvic floor support, reducing symptoms, and maintaining quality of life.

Common non-surgical treatment options include:

• Lifestyle modifications, such as managing constipation, avoiding heavy lifting, and addressing chronic coughing or straining
 • Pelvic floor physical therapy to strengthen and retrain the muscles that support the pelvic organs
 • Pessary therapy, which involves placing a removable medical-grade silicone device in the vagina to provide structural support to the bladder, uterus, or vaginal walls
 • Emsella® chair treatments, which help strengthen the pelvic floor through non-invasive, high-intensity muscle stimulation

Vaginal estrogen therapy to improve vaginal tissue health and comfort, particularly in postmenopausal women

Question 7

What is a pessary?

Accepted Answer

A pessary is a removable, medical-grade silicone device placed in the vagina to support pelvic organs that have shifted due to pelvic organ prolapse. Pessaries are a safe and effective non-surgical treatment option for women who wish to avoid or delay surgery, or those who are not surgical candidates. They can be used short-term or long-term, depending on individual needs and preferences.

A pessary is fitted during an office visit, where different sizes and styles are tried to ensure proper support and comfort. When correctly fitted, most women do not feel the pessary and are able to go about normal daily activities, including exercise. Some types of pessaries can be worn during intercourse, while others are removed beforehand, and this is discussed during the fitting process.

Many women are able to insert, remove, and clean their pessary on their own, while others prefer regular in-office management. With appropriate follow-up and vaginal tissue care, including vaginal estrogen when indicated, pessaries can be worn safely for extended periods of time. While a pessary does not cure pelvic organ prolapse, it can significantly improve symptoms, support pelvic anatomy, and enhance quality of life without surgery.

Question 8

When is surgery recommended for pelvic organ prolapse?

Accepted Answer

Surgery may be recommended when pelvic organ prolapse symptoms significantly affect quality of life or do not improve with conservative treatments such as pelvic floor therapy, pessary use, or non-invasive pelvic floor strengthening. Women who experience persistent vaginal bulging, pelvic pressure, difficulty with bladder or bowel function, or discomfort during daily activities may benefit from surgical repair.

Surgical treatment is highly individualized and based on the type of prolapse, symptom severity, overall health, and personal goals. We take a comprehensive approach to determine whether surgery is appropriate and discuss all available options in detail.

Question 9

Will pelvic organ prolapse worsen over time?

Accepted Answer

Pelvic organ prolapse can worsen over time, but progression is not inevitable. In many women, prolapse remains stable for years, especially when pelvic floor strength is maintained and contributing factors such as chronic straining or heavy lifting are addressed.

Early evaluation and treatment, including pelvic floor therapy, pessary use, or non-invasive pelvic floor strengthening, can help reduce symptoms and slow progression. Hormonal changes, particularly during menopause, may also influence pelvic support and symptom severity.

Question 10

Is pelvic organ prolapse related to menopause?

Accepted Answer

Yes. Pelvic organ prolapse is often influenced by hormonal changes that occur during menopause. Declining estrogen levels can lead to thinning and weakening of vaginal tissues, reduced collagen support, and decreased pelvic floor muscle strength, all of which can contribute to prolapse or worsening symptoms.

Addressing menopausal changes is an important part of prolapse management. Treatments such as vaginal estrogen therapy and comprehensive menopause care can help improve tissue health, comfort, and pelvic support. You can learn more about how hormonal changes affect pelvic health on our Menopause page.

Question 11

When should I see a urogynecologist for prolapse?

Accepted Answer

You should seek evaluation if you notice vaginal bulging, pelvic pressure, bladder or bowel changes, or discomfort affecting daily life or intimacy.

Pelvic Organ Prolapse