Pelvic organ prolapse treatment in Salt Lake City
Pelvic organ prolapse can cause pressure, heaviness, or a bulge in the vagina that tends to build through the day. It's common, it's rarely dangerous, and it can be treated. Elisabeth Ferlic, MD, is a board-certified urologist with fellowship training in female pelvic medicine and voiding dysfunction. She offers pelvic organ prolapse treatment in Salt Lake City, from pelvic floor therapy and pessary fitting through surgical repair.
Elisabeth Ferlic, MD
Board-certified urologist · Fellowship-trained in voiding dysfunction and female pelvic medicine
In this guide
- Symptoms of pelvic organ prolapse
- What is pelvic organ prolapse?
- Why see Dr. Ferlic for pelvic organ prolapse
- What are my options?
- Treatment options for pelvic organ prolapse
- Causes and risk factors
- How prolapse is diagnosed
- What to expect
- Self-management and prevention
- Benefits and risks, side by side
- What happens at the first visit?
- Pelvic organ prolapse FAQs
Symptoms of pelvic organ prolapse
Mild prolapse often causes no symptoms, and some women first hear about it during a routine pelvic exam. When symptoms appear, they are usually worse after hours of standing and better after lying down. Common symptoms include:
Pressure and bulging
- A bulge you can see or feel at or past the opening of the vagina
- Pelvic pressure or heaviness, as if something is falling out
- An ache in the lower back
- Trouble keeping a tampon in place
- Pressure or discomfort during sex
Bladder and bowel changes
- Leaking, urgency, a weak stream, or a feeling that the bladder doesn't empty
- Constipation, or the need to press on the vaginal wall to finish a bowel movement
When to seek urgent care
Prolapse is rarely an emergency. If you cannot urinate at all, seek emergency care. Fever with back or side pain and urinary symptoms also needs prompt assessment. A cystocele that blocks the flow of urine can lead to a bladder or kidney infection.
What is pelvic organ prolapse?
The pelvic floor is a group of muscles, ligaments, and connective tissue that supports the bladder, uterus, vagina, and rectum. Pelvic organ prolapse happens when that support stretches or weakens, and one or more organs drop and press into the wall of the vagina.
Doctors name each type of prolapse by the organ involved:
- Bladder prolapse (cystocele). The bladder drops into the front wall of the vagina. This type is the most common, and it's also called a dropped or prolapsed bladder.
- Rectocele. The rectum bulges into the back wall of the vagina.
- Uterine prolapse. The uterus drops down into the vagina.
- Vaginal vault prolapse. After a hysterectomy, the top of the vagina loses its support and drops, sometimes with the small intestine behind it (enterocele).
Two types are often present together. Doctors also grade prolapse from mild to complete, based on how far the organ has dropped.
Why see Dr. Ferlic for pelvic organ prolapse
Dr. Ferlic is a board-certified urologist and fellowship-trained in female pelvic medicine and voiding dysfunction. That fellowship included female pelvic reconstruction, the surgical field that covers prolapse repair.
Prolapse rarely arrives alone. It often comes with urinary leakage, urgency, incomplete emptying, or recurrent UTIs, and a urologist evaluates the bladder and the prolapse together. One physician follows you from the first conversation through testing, a pessary, and surgery if you choose it. She considers conservative treatment before any procedure.
Read more about her training on the About Dr. Ferlic page, or see related conditions on the women's pelvic health page.
What are my options?
A starting point for the conversation, not a prescription. Your evaluation decides what fits.
A mild prolapse that doesn't bother you
Some women first hear about it at a routine pelvic exam
Watchful waiting
Rechecked at regular visits, with treatment only if symptoms develop
Mild to moderate pressure or heaviness
Symptoms that build after hours of standing
Pelvic floor therapy
Exercises to contract and relax the muscles that support the organs
Bulge symptoms, without surgery
Long term, or while you consider surgery or plan more children
Pessary
A removable silicone device, fitted in the office, holds the organs in place
Symptoms conservative care hasn't eased
When therapy or a pessary hasn't been enough
Surgical repair
The operation depends on which organ has dropped
Treatment options for pelvic organ prolapse
Pelvic organ prolapse treatment depends on how much your symptoms bother you, not on the grade alone. The least invasive option that works comes first. Surgery enters the conversation only if you need it and choose it.
| Pelvic floor therapy | Pessary | Surgical repair | |
|---|---|---|---|
| How it works | A therapist teaches you to contract and relax the supporting muscles, and you continue at home | A removable silicone device sits in the vagina and holds the organs in place, like a brace | Repairs the support for the organ that has dropped, with your own tissue or, for some repairs, mesh |
| Best suited for | Mild to moderate prolapse | A long-term solution, or an interim step as you consider surgery | Symptoms that conservative treatment hasn't relieved enough |
| What to expect | Most women with mild symptoms notice a change within a few weeks | A fitting visit, a follow-up to confirm comfort, then periodic checks | Most women walk the same day; recovery takes one to six weeks |
| Limits | Can't lift an organ that has dropped a long way | Finding the right fit can take more than one try, and a poor fit can irritate the vaginal wall | Doesn't strengthen the underlying tissue, so prolapse can come back |
Pelvic floor therapy
- How it works
- A therapist teaches you to contract and relax the supporting muscles, and you continue at home
- Best suited for
- Mild to moderate prolapse
- What to expect
- Most women with mild symptoms notice a change within a few weeks
- Limits
- Can't lift an organ that has dropped a long way
Pessary
- How it works
- A removable silicone device sits in the vagina and holds the organs in place, like a brace
- Best suited for
- A long-term solution, or an interim step as you consider surgery
- What to expect
- A fitting visit, a follow-up to confirm comfort, then periodic checks
- Limits
- Finding the right fit can take more than one try, and a poor fit can irritate the vaginal wall
Surgical repair
- How it works
- Repairs the support for the organ that has dropped, with your own tissue or, for some repairs, mesh
- Best suited for
- Symptoms that conservative treatment hasn't relieved enough
- What to expect
- Most women walk the same day; recovery takes one to six weeks
- Limits
- Doesn't strengthen the underlying tissue, so prolapse can come back
Watchful waiting
A mild prolapse that doesn't bother you needs no treatment. Your doctor rechecks it at regular visits and acts only if symptoms develop.
Pelvic floor therapy
A pelvic floor physical therapist teaches you to contract and relax the muscles that support the pelvic organs, and you continue the exercises (Kegels) at home. Therapy works best for mild to moderate prolapse. It can ease symptoms and might slow progression, but it can't lift an organ that has dropped a long way. Dr. Ferlic prescribes it regularly.
Pessary
A pessary is a removable silicone device that sits in the vagina and holds the pelvic organs in place, similar to a brace. The fitting takes place in the office. Finding the right shape and size can take more than one try, and many women feel relief right away.
Some women remove and clean the pessary themselves. Others come in every few months to have it cleaned and checked, because a poor fit can irritate the vaginal wall. After menopause, vaginal estrogen is sometimes recommended to keep the tissue healthy, which is part of the hormone and menopause care. A pessary can be a long-term solution or an interim step as you consider surgery.
Surgical repair
Surgery is an option when conservative treatment hasn't been enough. The operation depends on which organ has dropped:
- Cystocele and rectocele repair (colporrhaphy). Working through the vagina, the surgeon tightens the tissue between the vagina and the bladder or rectum with stitches.
- Native tissue suspension. For uterine or vaginal vault prolapse, the top of the vagina is stitched to a ligament in the pelvis, using your own tissue.
- Sacrocolpopexy. Surgical mesh placed through the abdomen, often laparoscopically, attaches the vagina to the tailbone.
- Colpocleisis. This shorter operation closes off the vaginal canal. It suits women who don't plan to have vaginal intercourse again.
If you also leak with coughing or exercise, a sling or urethral bulking procedure can be part of the same plan.
What to know about surgical mesh
In 2019, the FDA ordered manufacturers to stop selling mesh for prolapse repair through the vagina in the United States. Mesh placed through the abdomen for sacrocolpopexy is a different use. It remains an option and has risks, including mesh exposure, pain, infection, and the possibility of further surgery. Many repairs use no mesh. Ask your surgeon which approach and material fit your condition. Mesh slings for stress incontinence are a separate treatment, described on the slings and urethral bulking page.
Request an appointment or call 435-344-4760.
Causes and risk factors
Vaginal childbirth is the most common cause. Pregnancy and delivery stretch the pelvic floor, and the risk is higher after several deliveries, a large baby, or a delivery that needed forceps or a vacuum. Symptoms often appear years later, most commonly after menopause, when lower estrogen levels weaken the supporting tissue further.
Other risk factors include:
- Getting older
- Extra body weight
- Chronic constipation and straining
- A long-term cough, including a cough from smoking
- Repeated heavy lifting
- Previous pelvic surgery, including hysterectomy
- A family history of prolapse, or a connective tissue condition
Most of these factors are outside your control. Prolapse isn't the result of something you did wrong.
How prolapse is diagnosed
Diagnosis starts with a conversation about your symptoms, and a pelvic exam usually confirms it. You might be asked to cough or bear down, and you might be examined both lying down and standing, because gravity changes how far the organs drop.
Prolapse and bladder problems often occur together, so a urologist also checks how well the bladder works. That can include a check for leaking with the prolapse held in place, a measurement of the urine left after you empty, and sometimes cystoscopy. Imaging such as ultrasound or MRI is reserved for complex cases.
Bladder and bowel symptoms aren't always caused by the prolapse itself; a repair doesn't fix a symptom the prolapse didn't cause. Sorting that out comes before any treatment decision.
What to expect
A first visit covers your history, an exam, and a plain explanation of which type of prolapse you have and what each option involves.
With pelvic floor therapy, most women with mild symptoms notice a change within a few weeks. With a pessary, expect a fitting visit, a follow-up to confirm comfort, and then periodic checks.
After surgical repair, most women walk the same day. Recovery takes one to six weeks, depending on the repair, with limits on lifting and strenuous exercise and nothing in the vagina, including intercourse, for about six weeks. Call your surgeon about worsening pain, fever, heavy bleeding, or signs of a urinary tract infection.
No treatment comes with a guarantee. Surgery repairs the bulge but doesn't strengthen the underlying tissue, so prolapse can come back.
Self-management and prevention
These habits take pressure off the pelvic floor. They can keep a mild prolapse from getting worse and help protect a surgical repair:
- Do pelvic floor exercises consistently, with correct technique.
- Prevent constipation with fiber and fluids, and don't strain on the toilet.
- Keep a healthy weight.
- Get a chronic cough treated, and stop smoking.
- Bend at the hips and knees when you lift, and get help with heavy loads.
If you plan to have more children, it's usually better to wait on surgery, because a later pregnancy raises the chance that the prolapse returns. A pessary can manage symptoms in the meantime.
Benefits and risks, side by side
Every treatment has trade-offs. Your history and your goals decide which ones matter most.
What treatment can address
- Pressure, heaviness, or a bulge in the vagina
- Discomfort that builds after hours of standing
- Leaking with coughing or exercise, with a sling in the same plan
What to weigh first
- How much your symptoms bother you, not the grade alone
- A repair doesn't fix a symptom the prolapse didn't cause
- Prolapse can come back after surgery
- Plans for more children, which can favor waiting on surgery
- Mesh has risks, and many repairs use none
What happens at the first visit?
The visit starts with what has changed and what you want help with. Any treatment and follow-up plan is specific to you.
Talk through your symptoms
Bring your concerns, medication list, and relevant medical history.
Decide what needs checking
Testing depends on your symptoms and history, and some concerns need a separate workup.
Discuss a plan and follow-up
Review benefits, risks, alternatives, and what to watch for.
Before you schedule
Ask which appointments are available and whether your concern suits a video visit or needs an in-person evaluation.
Here’s what our great patients say
Can pelvic organ prolapse be treated without surgery?
Yes. Pelvic floor therapy can ease mild to moderate prolapse, and a pessary relieves pressure and bulge symptoms for many women for years. Many women never need an operation.
Is a cystocele the same as bladder prolapse?
Yes. Cystocele is the medical term for a bladder that has dropped into the front wall of the vagina. Dropped bladder and prolapsed bladder describe the same condition, the most common type of pelvic organ prolapse.
Is a prolapsed bladder dangerous?
Usually not. Prolapse is uncomfortable, but it isn't life-threatening. In severe cases it can block the flow of urine, which can lead to infections or kidney damage, so trouble emptying your bladder is worth an evaluation.
Will I need a hysterectomy to fix prolapse?
Not always. Some repairs lift the uterus back into place without removing it. Whether to keep or remove the uterus depends on the prolapse, any separate uterine condition, and your preferences. Ask about uterus-preserving options and the reasons for any hysterectomy recommendation.
When can I make an appointment?
Contact the practice to ask which visit types are available and when in-person appointments and procedures can be scheduled.
Talk with a urologist about prolapse
Pressure, heaviness, and a bulge are treatable. Call 435-344-4760 or request an appointment, and ask about the next step.
If surgery has already been recommended elsewhere and you want another view, ask about a second opinion or records review.
This page is for general education and is not medical advice.