What is Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) is a common condition that will affect about 40% of women worldwide at some point in their life. It occurs when the muscles and tissues that support the pelvic organs—the bladder, uterus, vagina, urethra, and rectum—become weak or damaged. This causes the organs to drop or bulge into the vaginal canal. POP can be distressing, uncomfortable, and may significantly impact a woman's quality of life. However, there are treatment options available. To help you better understand this condition and recognize the symptoms, we’ll go over everything you need to know about pelvic organ prolapse and how to reduce your risk of developing this condition.

Different Types of Pelvic Organ Prolapse

Pelvic organ prolapse is a condition that occurs when the muscles and ligaments that support the pelvic organs weaken or stretch. This can cause the organs to bulge or protrude into the vagina, which may lead to discomfort, pain, and incontinence. There are several types of pelvic organ prolapse, each involving different organs and structures. Here are some of the most common types:

• Cystocele — this type of prolapse occurs when the bladder bulges into the front wall of the vagina. It can cause urinary incontinence, frequent urination, and a sensation of incomplete bladder emptying.

   

• Enterocele — an enterocele happens when the small intestine bulges into the upper part of the vagina. It can cause discomfort during sexual intercourse, as well as bowel problems like constipation.

   

• Rectocele — in this type of prolapse, the rectum bulges into the back wall of the vagina. It can cause difficulty with bowel movements, as well as discomfort during intercourse.

   

• Urethrocele — a urethrocele happens when the urethra bulges into the front wall of the vagina. It can cause urinary incontinence and difficulty emptying the bladder.

   

• Uterine Prolapse ­­— this type of prolapse occurs when the uterus slips down into the vagina. It can cause discomfort and pain in the lower back and pelvic region, as well as urinary and bowel problems.

   

• Vaginal Vault Prolapse ­— this happens when the top of the vagina loses support and drops down into the vaginal canal. It can cause discomfort and pain during sexual intercourse, as well as urinary and bowel problems.

Causes of Pelvic Organ Prolapse

Any type of pressure placed on the abdominal cavity can lead to pelvic organ prolapse, however, there are some things that increase your risk. Some of the risk factors of abdominal wall weakening include:

• Pregnancy and Childbirth — the strain and pressure of carrying a baby and giving birth can weaken the pelvic floor muscles and ligaments, which can result in prolapse.

   

• Menopause — as estrogen levels decline during menopause, the pelvic tissues can become thinner, weaker, and less elastic, increasing the risk of prolapse.

   

• Chronic Coughing — chronic coughing can put pressure on the pelvic floor muscles, leading to weakening and prolapse.

   

• Heavy Lifting — repeated heavy lifting or straining can also weaken the pelvic floor muscles, which could increase your risk of developing POP.

   

• Genetics — some women may be genetically predisposed to pelvic organ prolapse due to inherited structural weaknesses in their pelvic tissues.

   

• Obesity — being overweight or obese can put excess pressure on the pelvic floor muscles, thus increasing the risk of prolapse.

   

• Aging — as we age, the pelvic floor muscles naturally weaken and lose elasticity. This can increase the risk of prolapse, especially when combined with other factors.

  

  Symptoms of Pelvic Organ Prolapse

  Some cases of pelvic organ prolapse are very noticeable, while others may not be as obvious. Symptoms of POP can include:

• Backache
• Painful intercourse
• Feeling of pressure or fullness in the pelvic region
• Constipation
• Loss of bowel control
• Spotting or bleeding
• A feeling that something is falling out of the vagina
• Incontinence

These symptoms are not specific to pelvic organ prolapse and each type of prolapse may present unique signs. If you experience any of these, or other symptoms, don’t hesitate to schedule an appointment with your doctor.

Diagnosing Pelvic Organ Prolapse

Pelvic organ prolapse can be diagnosed through a physical exam and medical history review. During the exam, your healthcare provider will ask you to lie down and perform a visual and physical examination of your pelvis. They may also use a speculum to examine the vagina and cervix.

Your doctor may also perform a pelvic floor muscle strength test, where they ask you to contract your pelvic floor muscles as they try to pull their finger out of the vagina. This test can help determine the strength of your pelvic floor muscles and if there is any pelvic organ prolapse.

In some cases, imaging tests such as an MRI or ultrasound may be used to evaluate the extent and severity of the prolapse. Sometimes, pelvic organ prolapse can be difficult to diagnose, as symptoms can be similar to other conditions such as urinary tract infections or interstitial cystitis. Your doctor will work with you to make sure that you’re properly diagnosed and cared for.

How to Treat Pelvic Organ Prolapse

Pelvic organ prolapse can be a challenging condition to manage, but there are several treatment options available to help alleviate symptoms and improve quality of life. Some of the most common treatments for pelvic organ prolapse include the following.

Lifestyle Changes

Making certain lifestyle modifications can help reduce symptoms of pelvic organ prolapse. For example, losing weight if you are overweight or obese, avoiding heavy lifting and straining, and quitting smoking.

Pelvic Floor Exercises

Kegel exercises can help strengthen the pelvic floor muscles and alleviate symptoms of prolapse. Your healthcare provider can help you identify the muscles and provide guidance on how to perform the exercises correctly.

Hormone Therapy

Hormone therapy, such as estrogen replacement therapy, can help improve the strength and elasticity of the vaginal tissues and reduce symptoms of prolapse in postmenopausal women.

Vaginal Pessary

A vaginal pessary is a removable device that is inserted into the vagina to provide support for the pelvic organs. Pessaries come in a variety of shapes and sizes and can be an effective non-surgical option for managing pelvic organ prolapse.

Surgery

In severe cases of pelvic organ prolapse, surgery may be necessary to repair or support the pelvic floor. There are several surgical options available, including hysterectomy, colpocleisis, colporrhapy, sacrocolpopexy, sacrohysteropexy, and vaginal mesh repair. Your healthcare provider can help determine which surgical option is best for you based on your needs, type of prolapse, and medical history.

Ways to Prevent Pelvic Organ Prolapse

While it's not always possible to prevent pelvic organ prolapse, there are steps you can take to reduce your risk of developing it. Here are some lifestyle changes to make to help prevent POP.

Maintain a Healthy Weight

Being overweight or obese can put excess pressure on the pelvic floor muscles, increasing the risk of prolapse. Maintaining a healthy weight can help reduce this pressure. Try to eat a whole, nutritious diet and talk to your doctor if you’re struggling to lose excess weight.

Practice Pelvic Floor Exercise

Kegel exercises, which involve squeezing and releasing the muscles used to control urination, can help strengthen the pelvic floor muscles and reduce the risk of prolapse.

Avoid Heavy Lifting

Repeated heavy lifting can strain the pelvic floor muscles and lead to weakening and prolapse. If you must lift heavy objects, be sure to use proper lifting techniques and take breaks as needed. You can also wear postpartum compression garments to help keep your abdominal muscles tight.

Quit Smoking

Smoking can cause chronic coughing, which puts pressure on the pelvic floor muscles and can contribute to prolapse. Plus, smoking causes damages to several systems in your body, which can result in various complications.

Treat Constipation

Straining during bowel movements can weaken the pelvic floor muscles and increase the risk of prolapse. To help prevent constipation, try to eat a high-fiber diet, exercise regularly, and drink plenty of water throughout the day.

Talk to Your Healthcare Provider

If you have a family history of prolapse or other risk factors, talk to your healthcare provider about additional steps you can take to reduce your risk.

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