What Causes Pelvic Organ Prolapse?

Pelvic organ prolapse can be caused by various factors, including the vaginal delivery of an infant and improper medical care during childbirth. Pelvic organ prolapse is a distressing condition that occurs when the pelvic muscles are weakened or damaged, causing one or more of the organs in the pelvis to sag or prolapse into the vaginal canal.

Research indicates that 30-50% of women experience some form of pelvic organ prolapse in their lifetimes. In some cases, pelvic floor trauma can be a natural part of the birthing experience. In other cases, however, it is caused or worsened by improper care, negligence, or bad decisions made by the healthcare provider during childbirth.

Prolapse is not life-threatening but it can cause painful symptoms, as well as bladder and bowel problems. If you suffer from pelvic organ prolapse due to negligence or incompetent medical care, a medical malpractice lawyer can help you recover damages to ease the financial hardships you may be facing.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) is a condition in which the pelvic floor becomes too weak to hold organs in place. The pelvic floor comprises ligaments, muscles, and tissues that form a hammock-like structure across the pelvic opening. These muscles and tissues support pelvic organs, including the bladder, rectum, uterus, vagina, and small bowel. The pelvic floor plays a role in childbirth and sexual function, and also helps control urination and bowel movements.

Weakness or damage to the pelvic floor can lead to pelvic organ prolapse, urinary or fecal incontinence, and other related issues. Pelvic organs are said to prolapse if they sag or droop out of their normal position, descending into or outside the vaginal canal.

A pelvic organ prolapse can be large or small. A small prolapse, also called incomplete prolapse, is characterized by a mild or moderate drop of pelvic organs. This type of prolapse may not require surgery. A larger prolapse (complete prolapse) happens when the pelvic organs significantly shift out of place. In such cases, the organs may extend outside the vagina and cause a bulge. Severe cases of POP may need surgical repair.

A number of things can increase the risk of developing POP, including aging, being overweight, long-term pressure on the abdomen, having a hysterectomy, pregnancy and childbirth, and genetics. In some cases, however, pelvic organ prolapse is caused by medical malpractice.

Symptoms of Pelvic Organ Prolapse

Some women with POP experience no symptoms whatsoever, but others report the following symptoms:

• A feeling of heaviness or pressure around the lower tummy and genitals, or backaches in the lower back
• Constipation or loss of bowel control
• Spotting or bleeding from the vagina
• Pain, discomfort, or numbness during sex
• Urinary problems or constipation
• Having to shift protruding organs with the fingers
• Problems inserting tampons or menstrual cups

Some women report that their symptoms worsen at certain times of the day, after standing for a long time or engaging in physical activity.

Symptoms of pelvic organ prolapse depend to a certain extent on which organ is drooping. If the rectum prolapses, for instance, one may have uncomfortable intercourse or constipation. If the bladder prolapses, urine may leak. A backache often accompanies small intestine prolapse or uterine prolapse.

Different Types of Pelvic Organ Prolapse

The main types of pelvic organ prolapse are:

Cystocele (Anterior Vaginal Wall Prolapse)

A cystocele occurs when the pelvic floor muscles above the vagina weaken. The bladder slips out of place and vaginal tissue may bulge from the opening. Cystocele is the most common type of POP.

Rectocele (Posterior Vaginal Wall Prolapse)

This type of prolapse occurs when the wall of tissue that separates the rectum from the vaginal wall weakens. As a result, the front wall of the rectum drops and bulges onto the back wall of the vagina.

Rectal Prolapse

This occurs when the rectum loses the normal attachments that keep it in place, allowing it to protrude or prolapse through the anal opening. This is different from rectocele, where the rectum bulges onto the back wall of the vagina.

Uterine Prolapse

Weak supporting structures in the pelvic floor can cause the uterus to drop into the vaginal canal. In some cases, the uterus protrudes from the vagina.

Urethrocele

Damaged or weakened pelvic floor muscles and tissues can cause the urethra to droop down into the vagina. An urethrocele, also called an urethral prolapse, often accompanies a cystocele.

Enterocele

An enterocele occurs when a space develops between the rectum and the vagina, causing the small intestine (small bowel) to bulge onto the top or the back wall of the vagina. Women who’ve had a hysterectomy are most likely to experience an enterocele.

Vaginal Vault Prolapse

This type of pelvic organ prolapse occurs when the top part of the vagina (vagina vault) drops into the vaginal canal. In severe cases, it can protrude outside the vagina. This prolapse is caused by the weakening of muscles and tissues that support the upper portion of the vagina, which then changes shape and prolapses downward.

How to Treat Pelvic Organ Prolapse

There are several treatment options for POP, including vaginal pessary, kegel exercises, and surgery. Because of the risks associated with any surgical procedure, non-surgical procedures are usually the first line of treatment for pelvic organ prolapse. If these treatments are not effective, your physician may recommend surgery.

Pelvic Floor Strengthening Exercises (Kegel Exercises)

Observation and close follow-up are necessary for women with mild, asymptomatic cases of pelvic organ prolapse. Most women find relief from POP symptoms by performing pelvic floor muscle training exercises, commonly known as Kegel exercises. These targeted exercises allow a systematic contraction of the pelvic floor muscles. They have been proven to help improve the symptoms of stress incontinence, urge incontinence, and mixed incontinence, especially in women with mild POP.

Vaginal Pessary

Pessaries are another non-surgical management option for pelvic organ prolapse. A pessary is a removable device, often made of medical-grade silicone, that is inserted into the vagina to provide structural support and restore normal pelvic anatomy. Pessaries are an option for all stages of POP and help prevent the progression of prolapse and can delay the need for a surgical procedure.

Surgical Treatment

Surgery may be recommended if the symptoms haven’t improved with more conservative treatments. Prolapse repair can be done laparoscopically, transvaginally, robotically, or abdominally. Transvaginal surgeries have a higher success rate.

The purpose of surgical treatment is to correct anatomy and provide better vagina, bladder, and bowel function.

• Sacrocolpopexy: Treats enterocele and vagina vault prolapse. A surgical mesh is attached to the vaginal walls and the tailbone to lift the vagina back into place.
• Sacrohysteropexy: Corrects uterine prolapse. It involves using a strip of synthetic mesh to lift the uterus into place. This preserves childbearing function and allows for normal sexual function.
• Colporrhapy: Treats posterior or anterior vaginal wall prolapse. Dissolvable sutures are used to support the rectum and bladder.
• Uterosacral ligament suspension: The top of the vagina is attached to uterosacral ligaments in the pelvis, using stitches.
• Colpocleisis: This surgery results in a shortened vagina. The walls of the vagina are sewn together to hold pelvic organs in place. 

What Causes Pelvic Organ Prolapse?

Pelvic organ prolapse can be a natural part of the birthing experience. During pregnancy, the stretching of the uterus and the weight of a growing fetus can put pressure on the pelvic floor muscles and ligaments. The surge of hormones in a pregnant woman’s body also makes the tissues and muscles in the pelvis to become more flexible, usually beyond their rebound limits. And during vaginal delivery, the stretching and pushing involved can weaken or damage the pelvic floor muscles, causing pelvic organs to shift and sage into the vaginal canal.

Healthcare providers should make proactive and proper decisions when it comes to observing the size of the baby, the mother’s birth history, the mother’s pelvis shape, the mother’s health issues, and other important information. Communication breakdowns can also lead to medical errors, which can result in serious complications.

Here are some examples of medical malpractice that can lead to pelvic organ prolapse:

• Failure to diagnose or properly address issues that can lead to POP. For instance, some doctors settle on vaginal delivery despite a large baby, breech position, prolonged labor, and placenta previa.
• Improper use of vacuum extractors or forceps during delivery, causing tears in the pelvic floor muscles and ligaments.
• Improper suturing of episiotomy or tears, leading to pelvic floor dysfunction.
• Prolonged or excessive pulling on the baby during delivery, causing damage to the pelvic floor muscles.
• Failure to recognize distress in the baby can lead to emergency intervention that increases the risk of trauma to the pelvic floor.

Seeking Damages for Pelvic Organ Prolapse

Pregnant women depend on medical professionals to help ensure safe delivery. If a healthcare provider fails to uphold their duties or take certain measures to prevent pelvic organ prolapse, you may be eligible to pursue financial compensation from the at-fault party via a medical malpractice lawsuit.

In a medical malpractice case, you must prove the defendant was negligent and acted in a manner that constitutes a breach of duty. Also, you must show that the breach of duty caused you harm. Such cases often need expert testimony to explain the standard of care and establish causation.

It’s important to contact a birth injury lawyer to help you file a medical malpractice claim, advocate on your behalf, and get the compensation you need.