Bladder prolapse is also a common condition. Used to store urine, the bladder is a hollow organ in the pelvis. Pressure created when the bladder fills with urine is what causes the urge to urinate, when urine travels from the bladder and out the body through the ureter. In women, the uterus, or womb is held in place by the muscles, tissues and ligaments in the pelvis. Prolapse occurs when these supporting muscles, tissues and ligaments become weaker and are unable to hold the uterus in place.

There are varying degrees of prolapse:

  • First degree prolapse – when the uterus slips down into the vagina
  • Second degree prolapse – when part of the uterus sticks out of the opening of the vagina
  • Third degree prolapse – also called procidentia – when the entire uterus slips outside the vagina


Pelvic organ prolapse (POP) is a medical condition in which female pelvic organs, including the bladder, uterus, vagina and/or rectum, descend from their normal positions within the pelvis. These organs can sometimes protrude through the opening of the vagina. This condition is common, being symptomatic in approximately 30% of women 50-89 years of age and requiring a corrective procedure in 11% of women by 80 years of age.

POP occurs frequently with normal ageing in women who have had vaginal delivery or deliveries or prior hysterectomy, and in those who have increasing body-mass index, which predispose these women to weakening of the supporting ligaments and muscles in the pelvic floor.


Sacrocolpopexy is a surgical technique used to treat vaginal vault or uterine prolapse. This can be done via an open, laparoscopic or robotic approach. Dr Ruban is one of first urologists in Sydney to perform this procedure via a robotic laparoscopic approach following extensive rigorous training in this technique whilst in Paris. Dr Ruban has been invited to give a number of international presentations on robotic sacrocolpopexy and also teaches (proctors) other surgeons on how to perform robotic sacrocolpexy with successful outcomes.

More Information on Sacrocolpopexy

International Urogynecological Association – Sacrocolpopexy



The main factors commonly associated with causing a prolapsed bladder are:

  • Straining: Anything from lifting heavy products, straining during bowel movement, long-term constipation which causes damage to the muscles of the pelvis floor.
  • Childbirth: The most common cause, the childbirth delivery process is stressful on the vaginal tissues and muscles which support the bladder.
  • Menopause: Oestrogen, the hormone which maintains the strength of the vaginal muscles, is no longer produced after menopause, causing the muscles to weaken.


Your consultant will examine the pelvis and a bladder that has entered the vagina will confirm the diagnosis. In less obvious cases, the consultant may use a series of X-Rays taken during urination to help determine the shape of the bladder and the cause of urinary difficulty.

Following diagnosis, your consultant may test the nerves, muscles and the intensity of the urine stream to determine what type of treatment is most appropriate.

Cystoscopy may also be used to determine the best form of treatment; this procedure involves looking into the bladder with a scope.


Grade 1 prolapse that produces no pain or discomfort usually requires no medical or surgical treatment. However, your consultant may recommend you avoid lifting or straining.

For more serious cases, your consultant will assess the woman’s age, health, treatment of preference and the severity of the prolapse in order to determine which treatment is appropriate.

Surgical treatments include:

  • Robotic sacrocolpopexy
  • Laparoscopic sacrocolpopexy
  • Vaginal repair

Non-surgical treatments include:

  • Pessary: A pessary is placed into the vagina to hold the bladder in place; pessaries should be removed and cleaned at regular intervals to prevent infection. Oestrogen cream is also used to help prevent infection.
  • Oestrogen replacement therapy: Oestrogen helps strengthen and maintain the muscles in the vagina.