Harvard Health Letter

Pelvic organ prolapse

How does controversy affect your treatment?

Pelvic organ prolapse is in the national spotlight because the surgical mesh sometimes used to keep pelvic organs in place can cause complications: infection, pain, urinary trouble, and recurrence of the original problem. So what do you do if you're struggling with a sagging bladder, uterus, or rectum?

The sagging truth

For about 50% of mostly older women, the connecting tissues and muscles that hold the pelvic organs in place weaken and stretch over time, causing the organs to descend (prolapse) into the vagina. Sometimes an organ falls so much it's visible at the vaginal opening. That happens to 10% to 15% of all women, according to Dr. George Flesh, director of urogynecology and pelvic reconstructive surgery for Harvard Vanguard Medical Associates.

A little descent usually causes no symptoms at all. But once an organ descends into the vagina because of weakness of the vaginal wall, the trouble begins, and sometimes several prolapses occur together. The possibilities include a cystocele, when the bladder falls down or protrudes outside the vagina; a urethrocele, when the urethra bulges downward; a rectocele, when the rectum presses through a weakness in the back wall of the vagina and may protrude outside the vagina; uterine prolapse, when the uterus drops into the vagina and may protrude out; and vault prolapse, when the top of the vagina turns inside out in women who've had a hysterectomy.

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