Pelvic Organ Prolapse

Pelvic organ prolapse occurs when weakened pelvic floor muscles and connective tissues allow one or more pelvic organs, such as the bladder, uterus, or rectum, to descend into or beyond the vaginal canal. It is extremely common, especially after childbirth, menopause, or pelvic surgery.

While prolapse can range from mild pressure to a visible bulge, it is highly treatable, and many patients regain comfort, function, and confidence with the right care.

At The Medical Group of New Jersey, our urogynecology specialists provide a full spectrum of evaluation and treatment options, including pelvic floor therapy, pessary support, and minimally invasive pelvic reconstructive surgery. Treatment is always personalized to each patient’s symptoms, lifestyle, and goals.

Symptom Onset & Initial Evaluation

Pelvic organ prolapse often develops gradually. Early signs may be subtle, but progression can lead to more noticeable symptoms.

Common Symptoms Include:

• A feeling of pelvic heaviness or pressure
• A bulge or “something falling out” sensation
• Difficulty inserting or retaining tampons
• Low back discomfort or pelvic aching
• Urinary symptoms such as dribbling, incomplete emptying, or incontinence
• Constipation or the need to press on the vagina or perineum to have a bowel movement
• Discomfort during intercourse

Symptoms usually worsen with standing, lifting, or at the end of the day and may improve when lying down.

Types of Pelvic Organ Prolapse

• Cystocele (bladder prolapse)
• Rectocele (rectal prolapse into the vagina)
• Uterine prolapse
• Vaginal vault prolapse (after hysterectomy)
• Enterocele (small intestine herniation)

Evaluation

The initial evaluation focuses on identifying which organs are involved, the extent of prolapse, and how symptoms affect your day-to-day life. During the first visit, your urogynecologist will:

• Review symptoms, childbirth history, menopause status, and prior surgeries
• Discuss urinary, bowel, and sexual function
• Evaluate lifestyle factors and symptom triggers
• Perform a gentle pelvic exam to assess pelvic floor strength, tissue health, and prolapse severity
• Determine whether additional diagnostic testing is needed

Diagnosis & Testing

Diagnosis is primarily based on clinical evaluation, but additional testing may be recommended depending on symptoms.

• Pelvic Examination: Your provider will grade the prolapse using a standardized system (such as POP-Q) to determine which compartments are affected and how far the organs have descended.
• Post-Void Residual (PVR) Test: Measures how much urine remains in the bladder after voiding, especially if there are symptoms of incomplete emptying or urinary retention.
• Urinalysis: Screens for infection or blood in the urine, which may accompany prolapse-related emptying issues.
• Urodynamic Testing: Optional but useful when stress incontinence coexists with prolapse, surgery is being considered, or symptoms are complex or unclear.
• Pelvic Floor Muscle Assessment: Evaluates strength, coordination, and tone, helping guide therapy.
• Pelvic Ultrasound or MRI (rarely needed): Used when complex anatomy, prior surgeries, or multiple organ systems require further visualization.

All recommended diagnostic testing is coordinated on-site at The Medical Group of New Jersey for convenience and continuity of care.

Treatment & Ongoing Management

Treatment is individualized, depending on the severity of prolapse, presence of symptoms, and the patient’s preferences. Many women improve significantly without surgery; others choose surgical repair for more severe or life-limiting symptoms.

Lifestyle & Conservative Measures

Lifestyle changes can help prevent worsening of prolapse and reduce symptoms.

• Pelvic Floor Physical Therapy: This is typically a first-line treatment for mild to moderate prolapse. Therapy focuses on strengthening pelvic floor muscles, improving coordination and support, reducing pressure and heaviness, and teaching posture and breathing techniques.
• Behavioral Modifications: Avoiding chronic straining, treating constipation aggressively, managing body weight, avoiding heavy lifting, and using proper lifting mechanics.

Pessary Support

A pessary is a silicone device inserted into the vagina to support pelvic organs. It is an excellent option for women who want to avoid surgery, those who plan to have a pregnancy in the future, or patients who need temporary support before or after surgery. At The Medical Group of New Jersey, we fit pessaries in-office and teach patients how to remove, clean, and replace them, or we provide office-based maintenance if preferred.

Medication Therapy

While medications do not “fix” prolapse, they help with related symptoms. Commonly used options include topical estrogen for post-menopausal tissue health, vaginal moisturizers/lubricants for dryness or discomfort, and medications for overactive bladder if urgency or frequency coexist. Healthy pelvic tissues and symptom control improve comfort and quality of life.

Surgical Management

Surgery is recommended when the prolapse is moderate to severe, progressively worsening, or significantly affecting quality of life. At The Medical Group of New Jersey, we offer minimally invasive, robotic-assisted, and vaginal surgical options, including:

• Vaginal Repair (Native Tissue Repair): Repairs and reinforces weakened pelvic tissues without the use of synthetic mesh.
• Hysterectomy for Uterine Prolapse: If the uterus has descended, it may be removed as part of the repair when indicated.
• Sacrocolpopexy: A gold-standard, mesh-based abdominal repair (performed laparoscopically or robotically) that suspends the vaginal apex to the sacrum with excellent long-term outcomes.¹
• Uterosacral or Sacrospinous Fixation: These procedures support the top of the vagina.
• Rectocele Repair: Reinforces the posterior vaginal wall to improve bowel emptying.
• Combined Repairs: When multiple compartments are involved.

Surgical plans are always individualized and evidence-based.

1. Chang, Chia-Lun, et al. “An Updated Systematic Review and Network Meta-Analysis Comparing Open, Laparoscopic and Robotic-Assisted Sacrocolpopexy for Managing Pelvic Organ Prolapse.” Journal of Robotic Surgery, 15 Nov. 2021.

Monitoring & Follow-Up

Consistent follow-up ensures symptom improvement and long-term success. Follow-up includes:

• Pessary check or replacement
• Assessment of pelvic floor therapy progress
• Review of urinary and bowel function
• Post-operative evaluation and healing checks
• Monitoring for recurrence or new symptoms

With proper treatment, pelvic organ prolapse is very manageable and most patients feel significant relief. Symptoms like pressure, bulging, and bladder or bowel discomfort often improve. As these resolve, daily comfort and confidence return.

Modern nonsurgical and surgical therapies offer excellent long-term success, especially when overseen by experienced urogynecologists at The Medical Group of New Jersey.