Pelvic organ prolapse is a downward descent of female pelvic organs, including the bladder, uterus and the small or large bowel, resulting in protrusion of the vagina, uterus, or both. Prolapse development can be attributed to several factors, including vaginal child birth, advancing age and obesity, heavy lifting, repeated straining during bowel movements or various surgical procedures. Patients may present a variety of symptoms including urinary or fecal incontinence, vaginal discomfort or painful sexual relations. In many cases, patients are asymptomatic and pelvic organ prolapse may be discovered incidentally. Four main types of prolapse may occur: cystocele, enterocele, rectocele, or uterine prolapse
A cystocele occurs when the wall between a woman's bladder and her vagina weakens, causing the bladder to drop from its normal position. In its most advanced form, the bladder may bulge through the opening of the vagina.
Small bowel prolapse, known as an enterocele, occurs when the small intestine descends into the lower pelvic cavity, creating a bulge at the top part of the vagina. In women who have had surgery to remove the uterus (hysterectomy), small bowel prolapse is also called apical prolapse.
When the front wall of the rectum bulges into the back wall of the vagina, this is referred to as a rectocele. Rectoceles are usually due to thinning of the rectovaginal septum (the tissue between the rectum and vagina) and weakening of the pelvic floor muscles.
Uterine prolapse occurs when the uterus sags or slips from its normal position and descends into the vagina.