Pelvic Prolapse

  • Anterior Propapse
  • Posterior Prolapse
  • Small Bowel Prolapse
  • Risk Factors
  • Treatment

Anterior Propapse - Cystocele

Anterior prolapse, also known as a cystocele (SIS-toe-seel), occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. Anterior prolapse is also called a prolapsed bladder.

Straining the muscles that support your pelvic organs may lead to anterior prolapse. Such straining occurs during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. Anterior prolapse also tends to cause problems after menopause, when estrogen levels decrease.

Symptoms of Cystocele

In mild cases of anterior prolapse, you may not notice any signs or symptoms. When signs and symptoms occur, they may include:

 A feeling of fullness or pressure in your pelvis and vagina.
 A ‘ball’ in the vagina.
 Increased discomfort when you strain, cough, bear down or lift.
 A feeling that you haven't completely emptied your bladder after urinating.
 Repeated bladder infections.
 Pain or urinary leakage during sexual intercourse.
 A bulge of tissue that feels like you are sitting on an egg

Posterior Propapse - Rectocele

Posterior vaginal prolapse, also know as rectocele (REK-toe-seal) occurs when the thin wall of fibrous tissue (fascia) that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge. Posterior prolapse is called a rectocele because typically it's the front wall of the rectum that bulges into the vagina.

Childbirth, chronic constipation and other processes that put pressure on the fascia can lead to posterior prolapse. A small prolapse may cause no signs or symptoms. If a posterior prolapse is large, it may create a noticeable bulge of tissue through the vaginal opening. Though this bulge may be uncomfortable.

Symptoms of Rectocele

 Inability to fully evacuate a bowel movement without reducing the rectocele with your fingers. This is call ‘splinting’.
 A fullness of the vagina.
 A feeling that you haven't completely emptied your bladder after urinating.
 A bulge or ‘ball’ in the vagina.
 Pain at intercourse due to the rectocele.

Signs and symptoms often are especially noticeable after standing for long periods of time and may go away when you lie down.

Small Bowel Prolapse - Enterocoele

Small bowel prolapse, also called enterocele (EN-tur-o-seel), occurs when the small intestine (small bowel) descends into the lower pelvic cavity and pushes at the top part of the vagina, creating a bulge. The word "prolapse" means to slip or fall out of place.

Childbirth, aging and other processes that put pressure on your pelvic floor may weaken the muscles and ligaments that support pelvic organs, making small bowel prolapse more likely to occur.

To manage small bowel prolapse, self-care measures and other nonsurgical options are often effective. In severe cases, you may need surgical repair.

Risk Factors for Pelvic Prolapse

These factors may increase your risk of anterior prolapse:

 Childbirth. Women who have vaginally delivered one or more children have a higher risk of anterior prolapse.
 Aging. Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body's production of estrogen — which helps keep the pelvic floor strong — decreases.
 Hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor support.
 Genetics. Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse.

Increased pressure on the pelvic floor is the main reason for any form of pelvic organ prolapse. Conditions and activities that can cause or contribute to small bowel prolapse or other types of prolapse include:

 Pregnancy and childbirth
 Chronic constipation or straining with bowel movements
 Chronic cough or bronchitis
 Repeated heavy lifting
 Being overweight or obese

Pregnancy and Childbirth

Pregnancy and childbirth are the most common causes of pelvic organ prolapse. The muscles, ligaments and fascia that hold and support your vagina stretch and weaken during pregnancy, labor and delivery. Not everyone who has had a baby develops pelvic organ prolapse. Some women have very strong supporting muscles, ligaments and fascia in the pelvis and never have a problem.


Mild and moderate cases of prolapse typically don't need treatment. However, surgery can be quite effective if you have advanced prolapse with bothersome symptoms. Nonsurgical approaches are available if you wish to avoid surgery, if surgery would be too risky or if you want to become pregnant in the future.

Treatment options for prolapse include:

 Observation. If your prolapse causes few or no obvious symptoms, you don't need treatment. Simple self-care measures, such as performing exercises called Kegels to strengthen your pelvic muscles, may provide symptom relief. Avoiding heavy lifting and constipation may reduce the likelihood of worsening your prolapse.
 Pessary. A silicone, plastic or rubber device inserted into your vagina supports the bulging tissue. Pessaries come in a variety of styles and sizes. Finding the right one involves a custom fitting in the office by Dr. Wolpmann. You will have to learn how to insert, remove and clean it on a regular basis to avoid infections.


For some patients, outpatient surgery is an option. Dr. Wolpmann is the only surgeon in the area to perform surgery to repair pelvic prolapse without the use of mesh. His techniques restore normal anatomy with or without robotic assistance and primarily use a vaginal approach, affording faster recovery times.

A small bowel prolapse usually doesn't recur. However, further injury to the pelvic floor can happen with increased pelvic pressure, for instance with constipation, coughing, obesity or heavy lifting.