Pelvic organ prolapse treatment in Fort Worth

Many women live with a sense of pressure or a bulge for years before mentioning it. You don’t need to wait, and you don’t need to be uncomfortable to be taken seriously.

What is pelvic organ prolapse?

The bladder, uterus, and rectum are normally held in place by a hammock of pelvic floor muscles, ligaments, and connective tissue. When that support weakens or stretches, one or more of these organs can settle downward and press into the walls of the vagina — a condition called pelvic organ prolapse. Women often describe it as pressure, heaviness, a bulge, or the sensation that something is coming down, especially by the end of the day or after being on their feet.

Prolapse is named by which organ has lost support:

• Cystocele — the bladder pressing into the front wall of the vagina (the most common form)
• Rectocele — the rectum bulging into the back wall of the vagina
• Uterine prolapse — the uterus descending into the vaginal canal
• Vaginal vault prolapse — descent of the top of the vagina, which can occur after a prior hysterectomy
• Enterocele — a portion of small bowel pushing into the upper vagina

It’s very common to have more than one type at the same time, which is why a specialist evaluation — rather than treating a single symptom — matters. Prolapse is graded by how far the support has descended, and that grade helps guide whether to simply monitor it, manage it without surgery, or repair it.

How common is it?

Pelvic organ prolapse is far more common than most women realize. By some estimates, up to half of women who have given birth have some degree of prolapse on examination, though not all of them have symptoms. The lifetime chance of undergoing surgery for prolapse or incontinence has historically been estimated at around one in eight to one in five women. In other words, this is an ordinary, well-understood part of many women’s health — not something rare or shameful — and it is squarely within the expertise of a urogynecologist.

Why it happens

Prolapse develops when the pelvic floor’s support gives way — usually gradually, and usually from a combination of factors rather than one event. The most common contributors are:

• Vaginal childbirth, particularly multiple deliveries, large babies, or difficult deliveries, which stretch and can injure the support structures
• Menopause and loss of estrogen, which weaken connective tissue
• Aging and the natural decline in tissue strength and elasticity
• Chronic straining from constipation, a persistent cough, or repeated heavy lifting
• Prior pelvic surgery, including hysterectomy
• Genetics — some women inherit more elastic connective tissue and are simply more prone to it

Because the support weakens slowly, prolapse tends to progress over time if the contributing pressures continue. That’s not a reason to panic — it’s a reason to be evaluated, so you can choose treatment on your own timeline rather than waiting for it to worsen.

When should you see a specialist?

You should be evaluated whenever prolapse symptoms bother you — pressure, a bulge, or effects on your bladder, bowel, or comfort. There’s no need to wait until it’s advanced. Seek care promptly if you can feel or see tissue at the vaginal opening, if you’re having difficulty emptying your bladder, or if a bulge becomes irritated or exposed. Even mild prolapse is worth discussing, because understanding what you’re dealing with lets you make an informed choice about whether and when to treat it.

How we evaluate it

Diagnosis is usually straightforward and made during a gentle pelvic exam. We often ask you to bear down or examine you standing, so we can see how the support behaves under real-life conditions rather than only at rest. We’ll assess each compartment — front, back, and top — because prolapse frequently involves more than one, and we’ll check how it’s affecting your bladder and bowel, since those so often travel together.

We grade the prolapse so we can track any change over time and match treatment to its degree. If your bladder function needs a closer look before deciding on treatment, we may recommend additional in-office testing, always explained beforehand.

How we treat it

Treatment is tailored to how much the prolapse bothers you and what you want from life — not to a one-size-fits-all rule. Many women do beautifully without surgery; for those who choose repair, we offer advanced, minimally invasive options.

• Watchful waiting. Mild prolapse that isn’t bothering you can simply be monitored — no treatment is required unless and until you want it. We’ll keep an eye on it together.
• Pelvic floor physical therapy. Guided strengthening of the support muscles can relieve symptoms and slow progression, and is especially helpful in earlier prolapse. It’s a low-risk first step that also benefits any bladder or bowel symptoms.
• A pessary. A soft, removable silicone support fitted in the office holds the prolapse in place — an effective, entirely non-surgical option. Many women use one successfully for years, whether as a long-term solution or while deciding about surgery.
• Robotic-assisted reconstructive surgery. Robotic surgery is a large part of what we do — including robotic sacrocolpopexy, which restores support to the top of the vagina through a few small incisions. It offers excellent durability with less discomfort and a faster recovery than open surgery.
• Vaginal native tissue repair. When it’s the better fit for your anatomy and goals, prolapse can also be repaired through a vaginal approach using your own tissue — with no abdominal incisions. We choose the approach that gives you the most durable, appropriate result.
• Uterine-sparing options. When appropriate and desired, we can perform repairs that preserve the uterus rather than requiring its removal. We’ll talk through whether that’s a good fit for your situation.

Trusted resources

For further physician-reviewed patient education, we recommend Voices for PFD, from the American Urogynecologic Society (AUGS), and Your Pelvic Floor, from the International Urogynecological Association (IUGA) — the leading professional societies in our field. As always, the guidance most relevant to you is what we can offer after seeing you in person.