A prolapse means that an organ is no longer sitting in its normal position and has fallen and shifted from this position over time.
There are several types of pelvic organ prolapse. Patients may have more than one, because pelvic organs are interrelated.
Prolapse of the Rectum (Rectocele)
A prolapse of the rectal wall (back wall of the vagina) is also called a rectocele. When this wall weakens, it pushes against the vaginal wall, creating a bulge, which may become noticeable during bowel movements. It is different from rectal prolapse because it involves weakness in the tissues between the vagina and rectum.
Prolapse of the Bladder (Cystocele)
This "bladder drop" occurs when the front wall of the vagina prolapses. In many instances, it is accompanied by prolapse of the urethra (urethocele). When they occur together, the result is cystourethrocele. A common symptom of bladder or urethra prolapse is urinary stress incontinence (leaking of urine); for instance, while running, sneezing or coughing — although in more advanced cases the prolapse may actually obstruct urine.
Prolapse of the Uterus (Uterine Descensus)
A group of ligaments at the top of the vagina weaken, causing the uterus to fall. This causes the front and back walls of the vagina to weaken as well. The condition has several stages — from the first degree when the uterus drops into the upper portion of the vagina, to the fourth degree when it protrudes outside of the vagina.
Vaginal Vault Prolapse and Herniated Small Bowel (Enterocele)
With vaginal vault prolapse, the top of the vagina may fall toward the vaginal opening. It usually results from herniated small bowel — a weakening of the vaginal supports which causes the front and back walls of the vagina to separate and the intestines to push against the vaginal skin. Vaginal vault prolapse is likely to occur after a hysterectomy (removal of uterus) because the uterus provides support for the top of the vagina. Many patients with these types of prolapse have urinary incontinence; testing can further evaluate the anatomy and function of the pelvic floor.
