Pelvic Organ Prolapse

Pelvic Organ Prolapse: Diagnosis, Types, and Personalized Treatment Options in Ankara

The pelvis, or pelvic cavity, houses important organs such as the uterus, bladder, and rectum (the final section of the large intestine). These organs are held in their normal anatomical position by a strong support network known as the pelvic floor muscles, connective tissues (fascia), and ligaments. Over time, however, various factors can weaken or damage these supporting structures. As a result, one or more pelvic organs shift downward, bulging into the vagina or, in advanced cases, protruding outside the vagina. This condition is generally known as Pelvic Organ Prolapse (POP). POP is a fairly common condition whose incidence increases particularly with age and number of deliveries. It can negatively affect a woman’s quality of life by causing various complaints such as a feeling of fullness in the vagina, urinary incontinence, difficulty with bowel movements, and sexual dysfunction. Fortunately, pelvic organ prolapse is not inevitable, and today many effective treatment options are available, ranging from conservative (non-surgical) methods to modern surgical techniques. At her clinic in Ankara, Prof. Dr. Nuray Bozkurt specializes in performing a comprehensive evaluation of women experiencing pelvic organ prolapse and in determining and applying the most appropriate treatment method based on the type and degree of the problem.

What Is Pelvic Organ Prolapse (POP)? Why Is Pelvic Floor Support Important?

The pelvic floor consists of layers of muscle and connective tissue that wrap around the lower part of the pelvis like a hammock. The primary function of this structure is to support the bladder, uterus, and rectum that rest above it, to maintain urinary and bowel control, and to contribute to sexual function. Pelvic organ prolapse occurs when this supportive hammock-like structure loosens, weakens, or tears, causing the organs to sag downward under the effect of gravity.

What Are the Types of Pelvic Organ Prolapse? Which Organs Can Be Affected?

Prolapse is named according to which vaginal wall or organ has shifted downward. More than one organ often prolapses at the same time:

  • Cystocele (Bladder Prolapse): The most common type of prolapse. It is the herniation of the bladder toward the anterior wall of the vagina.
  • Rectocele (Rectal Prolapse / Bowel Herniation): The herniation of the rectum, the final section of the large intestine, toward the posterior wall of the vagina.
  • Uterine Prolapse: The downward descent of the uterus from its normal position into the vagina. It can occur in varying degrees.
  • Enterocele (Small Bowel Prolapse): The herniation of the small intestine, usually through the space behind the uterus, toward the upper part of the vagina. It can be seen particularly in women who have had a hysterectomy.
  • Vaginal Vault Prolapse (Vaginal Apex Prolapse): In women who have previously had their uterus removed (hysterectomy), this is the downward descent of the topmost point of the vagina.

A patient may have one or several of these prolapse types at the same time (for example, uterine prolapse together with a cystocele and rectocele).

What Causes Pelvic Organ Prolapse? Who Is at Greater Risk?

The main factors that weaken pelvic floor support and increase the risk of prolapse are as follows:

  • Pregnancy and Vaginal Delivery: The most important risk factor. In particular, multiple vaginal deliveries, delivering a large baby, and a prolonged or difficult labor (use of forceps/vacuum) can damage the pelvic muscles and ligaments.
  • Aging and Menopause: Tissues naturally weaken with advancing age. The decrease in estrogen that accompanies menopause also reduces the elasticity and strength of connective tissue, setting the stage for prolapse.
  • Chronic Increase in Intra-Abdominal Pressure: Conditions that continually increase intra-abdominal pressure place strain on the pelvic floor:
    • Chronic Cough: Due to causes such as COPD, asthma, and smoking.
    • Chronic Constipation: The constant need to strain.
    • Obesity: Excess body weight.
    • Repeated Heavy Lifting: Due to occupational or lifestyle factors.
  • Genetic Factors: Some women’s connective tissue may be structurally weaker (hereditary predisposition).
  • Previous Pelvic Surgery: Removal of the uterus (hysterectomy) in particular can weaken the supports of the vaginal vault and increase the risk of prolapse in later years.
  • Smoking: Increases the risk both by causing chronic cough and by impairing tissue quality.
  • Other Causes: Rarely, certain neurological or connective tissue disorders may also contribute to prolapse.

What Are the Symptoms of Pelvic Organ Prolapse? Which Complaints Occur?

The symptoms of prolapse vary depending on which organ has descended and to what extent. Mild prolapse usually causes no symptoms. When symptoms do occur, the most common are as follows:

General Sensation of Prolapse and Pain:

  • A downward pulling, fullness, pressure, or heaviness sensation in the vagina. This sensation usually increases with standing or toward the end of the day and eases when lying down.
  • A feeling as though something is about to come out of the vagina, or a sensation of a ball inside the vagina.
  • A mass protruding from the vagina that can be felt or seen (especially while straining).
  • Dull, constant, or intermittent groin or lower back pain.

Urinary Symptoms (Usually With a Cystocele):

  • Urinary incontinence (stress type – during coughing, sneezing, laughing, or exercise).
  • Frequent urge to urinate.
  • Sudden, urgent need to urinate and inability to reach the toilet in time (urge incontinence).
  • Difficulty initiating urination or a weak urine stream.
  • A feeling of incomplete bladder emptying.
  • Needing to press on the vagina or lower abdomen with the hand in order to urinate.
  • Frequently recurring urinary tract infections.

Bowel Symptoms (Usually With a Rectocele):

  • Chronic constipation or the need for excessive straining during bowel movements.
  • A feeling of incomplete bowel emptying.
  • The need to press a finger against the posterior vaginal wall or around the anus to facilitate bowel movements (splinting).
  • Rarely, fecal incontinence.

Sexual Symptoms:

  • Pain during intercourse (dyspareunia).
  • A feeling of vaginal looseness or laxity.
  • The prolapsed tissue interfering with or causing discomfort during intercourse.
  • Decreased sexual desire or difficulties reaching orgasm.

If you are experiencing one or more of these symptoms, it is recommended that you consult a gynecology and obstetrics specialist for an evaluation.

How Is Pelvic Organ Prolapse Diagnosed? Evaluation in Ankara

Pelvic organ prolapse is usually diagnosed through the patient’s complaints and a careful gynecological examination. The evaluation process carried out by Prof. Dr. Nuray Bozkurt in Ankara includes the following:

  1. Detailed History Taking: The patient’s symptoms (sensation of prolapse, urinary, bowel, and sexual function complaints), when these symptoms began, their severity, and the extent to which they affect quality of life are recorded. Risk factors (number and type of deliveries, menopausal status, chronic illnesses, previous surgeries, etc.) are questioned in detail.
  2. Pelvic Examination: This forms the basis of the diagnosis. On the gynecological examination table, the doctor assesses the vaginal walls and the position of the pelvic organs both while the patient is relaxed and while coughing or straining. A speculum examination is used to determine the position of the cervix, prolapse of the anterior and posterior vaginal walls (cystocele, rectocele), and the degree of prolapse. The strength of the pelvic floor muscles may also be assessed. A cough test may be performed to check for stress urinary incontinence.
  3. Additional Tests (When Deemed Necessary):
    • Urinalysis and Urine Culture: To rule out infection.
    • Postvoid Residual Urine Volume: Measured by ultrasound or catheterization to determine whether the bladder is emptying completely.
    • Urodynamics: Tests performed particularly in patients with complex urinary complaints such as incontinence or difficulty voiding, in order to evaluate bladder and urethral function in detail and to assist in surgical treatment planning.
    • Pelvic Floor Imaging (Ultrasound or MRI): Although not necessary in most cases, this may rarely be used to obtain a more detailed view of the anatomy in complex cases where the diagnosis is unclear or other coexisting pathologies are suspected, or for surgical planning.

Pelvic Organ Prolapse Treatment Options: Modern Approaches in Ankara

Treatment for pelvic organ prolapse is planned on a personalized basis according to the type and degree of prolapse, the patient’s age, general health, sexual activity status, desire for future children, and the extent to which symptoms affect quality of life. In Ankara, Prof. Dr. Nuray Bozkurt shares all treatment options with her patients and reaches the most appropriate decision together with them.

1. Conservative (Non-Surgical) Treatment Methods: These are first-line treatment options for patients with mild to moderate prolapse, mild symptoms, or who do not want surgery or are not suitable candidates for it:

  • Lifestyle Changes: Measures such as losing weight, quitting smoking, treating chronic cough and constipation, and avoiding heavy lifting can slow the progression of prolapse and ease symptoms.
  • Pelvic Floor Muscle Exercises (Kegel Exercises): Exercises aimed at strengthening the pelvic floor muscles. When performed regularly and correctly, they can be beneficial for mild prolapse and especially for stress urinary incontinence. It is important to learn the correct technique from a physiotherapist.
  • Use of a Pessary: Supportive devices made of silicone or plastic, in various shapes and sizes, that are placed inside the vagina. They relieve symptoms immediately by holding the prolapsed organs in place. They can be used as an alternative to surgery or as a temporary solution while awaiting surgery. The appropriate pessary must be selected by a doctor and requires regular maintenance.
  • Local Vaginal Estrogen Therapy: Low-dose estrogen creams, tablets, or rings may be used in postmenopausal women to improve the health and elasticity of vaginal tissue. This can ease prolapse symptoms and accompanying complaints such as dryness.

2. Surgical Treatment (Pelvic Reconstructive Surgery): Surgical treatment is considered for patients with severe symptoms, significantly impaired quality of life, or who have not benefited from conservative treatments. The goal of surgery is to restore the prolapsed organs to their correct anatomical position and to repair the weakened supporting tissues. The surgical technique used is highly varied and is determined according to the patient’s condition:

  • Vaginal Approach: Most operations can be performed through the vagina, without any externally visible incision. This approach is generally less painful and allows for faster recovery.
    • Anterior Repair (Anterior Colporrhaphy): The anterior vaginal wall is repaired to correct bladder prolapse (cystocele).
    • Posterior Repair (Posterior Colporrhaphy): The posterior vaginal wall is repaired to correct rectal prolapse (rectocele).
    • Vaginal Hysterectomy: If uterine prolapse is present and the patient does not wish for future children, the uterus is removed through the vagina. Cystocele and rectocele repair are usually performed in the same session.
    • Vaginal Vault Suspension Procedures: Whether the uterus has been removed or is being preserved, procedures to suspend the vaginal apex or uterus to strong ligaments (sacrospinous ligament, uterosacral ligament) can be performed through the vagina.
  • Abdominal (Open) or Laparoscopic/Robotic Approach: Operations performed through an abdominal incision (open) or through small incisions (laparoscopic/robotic). These may be preferred especially for suspension procedures in which the uterus is preserved (sacrohysteropexy) or for suspending the vaginal vault to the sacrum bone (sacrocolpopexy). Laparoscopic and robotic techniques allow for faster recovery due to their minimally invasive nature.
  • Use of Mesh (Synthetic Patch): In some repair operations, particularly for recurrent prolapse or when tissues are very weak, synthetic or biological patches (mesh) may be used to reinforce support. However, because mesh use carries its own potential complications (erosion, pain, infection), its use is limited to selected cases and must be discussed in detail with the patient.
  • Obliterative Procedures (Colpocleisis): A procedure that partially or completely closes the vagina, performed in patients who are not sexually active, are elderly, and are not suitable candidates for major surgery due to additional health problems.

Prof. Dr. Nuray Bozkurt performs the operation by selecting the surgical technique (vaginal, laparoscopic) best suited to the patient’s needs and anatomy.

Recovery and Expectations After Pelvic Organ Prolapse Surgery

The recovery process varies depending on the type and extent of the surgery performed and the surgical approach used (vaginal, laparoscopic, open). Minimally invasive techniques (vaginal, laparoscopic) generally allow for faster recovery.

  • Hospital Stay: Can range from 1 to 3 days.
  • Pain: Postoperative pain is usually controlled with pain relievers.
  • Activity Restrictions: It is very important to avoid heavy lifting, straining, strenuous exercise, and sexual intercourse for a certain period after surgery (usually 4-8 weeks). This is necessary for the repaired tissues to heal properly.
  • Preventing Constipation: Avoiding constipation and straining during the recovery period is critical. A high-fiber diet, adequate fluid intake, and stool softeners if needed are recommended.
  • Long-Term Success and Recurrence: Success rates for surgical treatment are generally high. However, if underlying risk factors (obesity, chronic cough/constipation, weak connective tissue) persist or new factors are added, prolapse can recur over time in a different area or the same area. Measures such as weight control and pelvic floor exercises contribute to long-term success.

Prof. Dr. Nuray Bozkurt’s Expertise and Approach to Pelvic Organ Prolapse Treatment in Ankara

Prof. Dr. Nuray Bozkurt offers her patients in Ankara an expert and compassionate approach to the diagnosis and treatment of important issues affecting women’s quality of life, such as pelvic organ prolapse:

  • Comprehensive Evaluation: Carefully listening to the patient’s complaints and needs, she accurately determines the type and degree of prolapse through a detailed pelvic examination.
  • Individualized Treatment: Recognizing that there is no single correct treatment, she selects the most suitable treatment option (conservative or surgical) together with the patient, based on the patient’s age, health status, lifestyle, and expectations.
  • Conservative Treatment Options: She provides guidance on Kegel exercises and carefully performs pessary fitting and follow-up for suitable patients.
  • Modern Surgical Techniques: When surgery is needed, she aims for faster and more comfortable recovery by using minimally invasive methods, particularly vaginal surgery and laparoscopic surgery. She considers uterus-preserving surgical options in suitable patients.
  • Holistic Approach: She also takes into account urinary incontinence or bowel problems that may accompany prolapse and, when necessary, works in coordination with related specialties.
  • Patient Education and Support: She provides her patients with detailed information about their condition, treatment options, the surgical process, and postoperative precautions, and offers support throughout the entire process. Accessibility is essential (0538 983 18 78) (0312 284 00 12).

If you are experiencing discomfort due to symptoms of pelvic organ prolapse or suspect that you may have this condition, seeking professional help without hesitation can significantly improve your quality of life. By making an appointment with Prof. Dr. Nuray Bozkurt at our clinic in Ankara, you can obtain detailed information about your condition and create your own personalized treatment plan. You can reach us at 0538 983 18 78.

Frequently Asked Questions

Pelvic organ prolapse is the descent of pelvic organs such as the uterus, bladder, and rectum into or out of the vagina, resulting from weakening of the muscles and ligaments that support them. Not only the uterus, but also the bladder (cystocele) or rectum (rectocele) can prolapse on their own or together.

The most common causes are multiple vaginal deliveries, aging, and menopause. Chronic cough, constipation, obesity, and genetic predisposition are also important risk factors.

Mild prolapse may not cause any symptoms. When symptoms do occur, the most common are a feeling of fullness in the vagina, downward pressure, a palpable mass, and lower back pain. Urinary incontinence, difficulty urinating, constipation, difficulty with bowel movements, and sexual problems may also accompany it.

The diagnosis is usually made through a detailed patient history and a careful gynecological examination. The doctor determines the type and degree of prolapse by having the patient strain. Additional tests such as urodynamics may rarely be required.

No, not every prolapse requires surgery. In mild prolapse or cases without symptoms, conservative methods such as Kegel exercises and lifestyle changes, or the use of a pessary (vaginal ring), may be sufficient. Surgery is recommended for patients with severe complaints or who have not benefited from conservative treatment.

A pessary is a device made of silicone or plastic that is placed inside the vagina to support and hold prolapsed organs in place. It is an effective non-surgical treatment option for patients who do not want surgery or are not suitable candidates for it. The appropriate type and size is selected by the doctor and it requires regular maintenance.

Surgery is usually performed through the vagina, and sometimes with a laparoscopic (minimally invasive) or open technique. The goal is to restore the prolapsed organs to their normal position and repair the supporting tissues. If uterine prolapse is present and the patient does not want future children, the uterus is usually also removed (vaginal hysterectomy). However, if preserving the uterus is desired, procedures to suspend the uterus upward can also be performed.

Recovery varies depending on the type of surgery (vaginal/laparoscopic is usually faster). It is very important to avoid heavy lifting, straining, strenuous exercise, and sexual intercourse for a certain period (4-8 weeks) after surgery. Care should be taken to avoid constipation.

Yes, prolapse can recur over time, especially if risk factors persist (obesity, constipation, etc.) or if the connective tissue is weak. Lifestyle measures and Kegel exercises can help reduce the risk of recurrence.

If you have complaints related to pelvic organ prolapse, you can make an appointment at Dr. Nuray’s clinic in Ankara by calling 0538 983 18 78 to get information about evaluation and treatment options.

You can contact us for information about the diagnosis and treatment process.

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What Is Pelvic Organ Prolapse?

Pelvic organ prolapse is the downward displacement of the uterus, bladder, or large intestine located within the pelvis, resulting from the weakening of the muscles and connective tissue (pelvic floor) that hold these organs in place. We can think of the pelvic floor as a strong support structure that carries these organs like a hammock. If this structure loses its elasticity or becomes damaged, the organs can prolapse outward through the vaginal area.

In Ankara, Prof. Dr. Nuray Bozkurt applies modern surgical and non-surgical treatment methods that both improve quality of life and permanently correct this condition in patients experiencing pelvic organ prolapse. This is not merely a physical discomfort; it is a health issue that also leads to urinary incontinence, sexual dysfunction, and a serious loss of comfort.

What Causes Pelvic Organ Prolapse? Risk Factors

There are many factors that lead to weakening of the pelvic floor muscles and prolapse of these organs. This condition is usually the result of effects accumulated over time rather than a single cause:

  • Pregnancy and Childbirth: Difficult, assisted (vacuum, forceps) deliveries, or a high number of vaginal deliveries in particular, are the factors that cause the greatest damage to pelvic floor tissues.

  • Age and Menopause: Tissue elasticity decreases with age. The drop in estrogen levels that accompanies menopause is a critical factor causing weakness in the pelvic floor muscles.

  • Chronic Straining: Persistent constipation and straining, chronic cough (such as from asthma or COPD), or heavy lifting increase intra-abdominal pressure and push the organs downward.

  • Obesity: Excess weight creates constant pressure on the pelvic muscles, setting the stage for tissue prolapse.

  • Genetic Predisposition: Some women may have inherently weaker connective tissue from birth.

Types of Pelvic Organ Prolapse

Prolapse takes different names depending on which organ has shifted. These conditions often occur together:

  • Cystocele (Bladder Prolapse): The downward prolapse of the bladder through the anterior vaginal wall. It is the most common type of prolapse and usually presents with urinary complaints.

  • Rectocele (Bowel Prolapse): The forward prolapse of the final section of the large intestine through the posterior vaginal wall. It can cause difficulty with bowel movements.

  • Uterine Prolapse: The descent of the uterus into or out of the vagina.

  • Cervical Prolapse (Vaginal Apex Prolapse): The downward descent of the top of the vagina, particularly in women who have previously had their uterus removed.

Symptoms: How Might You Feel?

Women experiencing pelvic organ prolapse typically present to our clinic with the following complaints:

  1. Feeling of Fullness in the Vagina: A sensation of pressure as though there is a ball inside the vagina or something is about to come out.

  2. Palpable Mass: In advanced-stage prolapse, a soft tissue mass that can be felt at or outside the vaginal opening.

  3. Urinary Problems: Urinary incontinence with laughing, coughing, or sneezing (stress incontinence), incomplete bladder emptying, or frequent urination.

  4. Difficulty with Bowel Movements: A feeling of incomplete bowel emptying or, in the case of a rectocele, the need to press on the posterior vaginal wall to have a bowel movement.

  5. Sexual Dysfunction: Pain during intercourse (dyspareunia) or reduced sexual desire due to hesitation related to the prolapse.

  6. Lower Back and Abdominal Pain: Day

Diagnosis and Staging: How Is the Severity of the Condition Determined?

Pelvic organ prolapse can be easily diagnosed with an expert gynecological examination. At our clinic in Ankara, the following methods are used during the diagnostic process:

  • Pelvic Examination: The patient is examined both in a lying position and while straining. This allows determination of which organ is affected by the prolapse and its severity (stage).

  • POP-Q System: An international measurement system that determines the level of prolapse in millimeters. It is our most important guide in the treatment decision (surgery or observation?).

  • Urodynamic Tests: If the patient also has a complaint of urinary incontinence, these tests may be used to assess bladder function.

  • Imaging: Pelvic ultrasound or MRI may be requested in rare and complex cases.

Pelvic Organ Prolapse Treatment Options

Not every case of prolapse requires surgery. The treatment plan is determined based on the stage of prolapse, the severity of the patient’s complaints, her age, and her general health.

1. Non-Surgical Methods (For Early Stages)

The following methods are preferred for mild-degree prolapse or in patients who are not able to undergo surgery:

  • Pelvic Floor Exercises (Kegel): Helps stop the progression of prolapse by strengthening the pelvic muscles.

  • Vaginal Pessaries: Silicone rings placed inside the vagina that hold the organs in place. They are a comfortable solution for patients who do not want surgery or who have a high surgical risk.

  • Lifestyle Changes: Losing weight, preventing constipation, and avoiding heavy lifting support the success of treatment.

2. Surgical Treatment (Permanent Solution)

Surgery is the most effective solution for moderate and advanced-stage prolapse. Today, these operations are performed using two main approaches:

Vaginal Operations: The repair of prolapsed tissues entirely through the vagina, without any abdominal incision. The recovery process is quite fast.

Minimally Invasive (Laparoscopic/Robotic) Operations: A modern method preferred especially for uterine prolapse or vaginal vault prolapse. Small incisions are made in the abdomen, and the organs are suspended to where they should be (usually to the tailbone) with the help of special mesh. Laparoscopic Sacrocolpopexy is one of the most successful methods for minimizing the risk of prolapse recurrence.

Frequently Asked Questions

Must the uterus always be removed after prolapse surgery? No. Today, thanks to uterus-preserving surgeries (sacrohysteropexy), it is possible to correct prolapse without removing the uterus.

Does prolapse recur after surgery? The success rate is very high when the correct technique is used and performed by experienced hands. However, excessive weight gain or heavy physical strain can increase the risk of recurrence.

Does prolapse affect sexual life? Yes, prolapse can cause vaginal laxity and pain. After surgery, as the pelvic structure returns to its previous state, a marked improvement in sexual quality of life is observed.

Ankara Pelvic Floor Health and Appointments

Pelvic organ prolapse is not a “natural consequence of aging” and does not have to be your fate. Thanks to modern medical approaches, it is possible to permanently overcome this problem. Prof. Dr. Nuray Bozkurt offers personalized solutions for pelvic floor repair and aesthetics at her clinic in Ankara.

Detailed Information and Appointments: 0312 284 00 12