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How Childbirth Can Lead to Pelvic Organ Prolapse

February 21, 2019

In a perfect world, things stay where they’re supposed to stay and perform the way they’re supposed to perform. There’s nothing perfect, however, about the way childbirth stretches and tears the ligaments in a woman’s pelvis that hold up her internal organs. When they are worn out, the uterus, bladder and rectum can drop lower than they should and even protrude through the vagina, causing a host of issues when urinating and moving the bowels. But Dr. Christine LaSala, director of the Urogynecology Division at Hartford Hospital and a Tallwood Urology & Kidney Institute urogynecologist, said women do not need to suffer in silence about a condition called pelvic organ prolapse. “Four out of 10 women who’ve had vaginal deliveries will develop prolapse. Of those four, one will need surgery to fix the problem,”   Dr. LaSala said. “Yet it’s something women still don’t want to talk about and they will adapt and put up with it as long as they can.” Anatomically, the bladder, uterus and rectum/bowels are supported in a woman’s pelvic region by pelvic floor muscles and a hammock of ligaments and connective tissue. When the pelvic floor muscles – the ones targeted by Kegel exercises – are damaged from childbirth, the body relies on the hammock to support the organs. “This is not a good thing because the hammock is supposed to stretch during pregnancy to allow room for the developing baby,” Dr. LaSala said. As women age, the organs may continue to drop further into the vagina. Signs of pelvic organ prolapse include:

  • Bulge in the vagina where the organ is actually protruding out of the body.
  • Strong urge to urinate but when you try to go, you can’t without pushing the bulge back up, a condition called voiding dysfunction.
  • Urine leakage.
  • Difficulty moving the bowels because stool gets “stuck” in the rectal bulge.
“Women are embarrassed by this and actually feel less feminine,” Dr. LaSala said, adding that a partner might notice something different during intercourse as well. She offered several options for treating pelvic organ prolapse:
  • Inserting a pessary as a conservative, nonsurgical approach. A pessary is a flexible device inserted into the vagina to support the uterus, vagina, bladder or rectum. Most women are candidates for this option and Dr. LaSala said “it buys them some time but it will not reverse things.”
  • Surgery. A patient's needs, expectations and lifestyle will dictate the surgical approach that can be taken for prolapse. One option is a vaginal bladder tuck, a one-day procedure to tighten the hammock under the bladder, although the prolapse may recur. Hysterectomy may be the answer if it is the uterus that is prolapsed. A third option is laparoscopic through an incision, using a mesh graft or the patient’s own tissue, to tighten the tissue in the pelvis.
The first step for women who feel they have prolapse is to speak with their primary care physician or gynecologist, Dr. LaSala said. They can then be referred to a urogynecologist, a specialist like her whose focus is the health of the female urinary tract. For more information on pelvic organ prolapse or the Tallwood Urology & Kidney Institute's Division of Urogynecology, click here.