5 Things You Should Know About Pelvic Organ Prolapse

1. Pelvic organ prolapse occurs when organs in the pelvis shift out of place

Pelvic organ prolapse is a type of pelvic floor disorder that occurs when muscles, ligaments and connective tissues supporting your uterus, bladder or rectum become weak or stretched. When that support gives out, these organs may drop or press into the vaginal wall.

“Imagine a hammock that’s supposed to hold everything in place but has become too loose, so the organs it supports start to droop,” said Greg J. Marchand, M.D., a board-certified OB-GYN at The Marchand Institute for Minimally Invasive Surgery.

There are several types of pelvic organ prolapse, including:

• Cystocele (anterior): Bladder slips into the vagina
• Enterocele (posterior): Small intestine bulges into the vagina
• Rectocele: The rectum drops into the vagina
• Uterine prolapse: The uterus slips into the vagina
• Vaginal vault prolapse: The top part of the vagina weakens and drops

2. Several factors can increase your risk of pelvic organ prolapse

Marchand lists the following as the most common risk factors of pelvic organ prolapse:

• Childbirth: Having more than one baby, delivering vaginally, large babies and deliveries involving tools like forceps can weaken the pelvic floor
• Aging: Low estrogen levels can weaken pelvic tissues over time
• Chronic pressure:Obesity, heavy lifting or long-term coughing from smoking or lung problems can add extra stress to the pelvic floor
• Genetics or connective tissue disease: Some people are more likely to have POP if they naturally have weaker connective tissues
• Constipation: Excessive straining during bowel movements can weaken pelvic floor muscles
• Pelvic surgeries: Procedures like hysterectomy or radiation can affect the pelvic floor

3. Pelvic organ prolapse symptoms can range from mild to hard to ignore

Symptoms of POP can vary depending on the type and severity of the prolapse. While some women with mild pelvic organ prolapse may not have any symptoms, others may notice signs like:

• Feeling or seeing a bulge at or near the vaginal opening
• Heavy or full feeling in the pelvis
• Lower back pain
• Urinary changes, including urinating more often, frequent urge to urinate or difficulty emptying bladder
• Bowel problems, including not completely emptying or needing to press on the vagina to help pass stool (known as splinting)
• Pain or discomfort during sex

4. Pelvic organ prolapse can get worse if left untreated

POP doesn’t clear up on its own. Without treatment, the condition can get worse over time, with symptoms becoming more bothersome and potentially affecting your day-to-day life. Untreated prolapse could lead to complications like urinary tract infections (UTIs), sores on the cervix or injuries to other pelvic organs.

“You should see a healthcare provider if you experience any symptoms of pelvic organ prolapse that are interfering with your daily life,” Marchand said. “Most commonly, a woman will feel a bulge in her vagina, or a feeling that something is ‘falling out.’ Some women may also have problems with urination or bowel movements. Pelvic pressure or pain that disrupts your daily life is another reason to seek care.”

5. There are many pelvic organ prolapse treatment options

Many pelvic organ prolapse treatments exist, but your healthcare provider will ultimately recommend which one is best for your symptoms, age, overall health and lifestyle.

Here’s a quick overview of the most common treatments and lifestyle recommendations:

• Pelvic floor therapy: Exercises that help strengthen the pelvic floor by contracting and relaxing muscles around the urethra, vagina and rectum
• Pessary: A removable device inserted in your vagina to support the pelvic organs that have dropped
• Lifestyle changes: Losing weight, avoiding heavy lifting or treating constipation with more fiber and water can lessen strain on the pelvic floor“If symptoms are severe or other treatments don’t help, surgery can repair the prolapse by lifting organs back into place or, in some cases, removing the uterus,” Marchand explained.

Common surgeries for pelvic organ prolapse include:

• Colpocleisis: Shortens the length of the vagina
• Sacrocolpopexy: Repairs uterine and vaginal vault prolapse
• Sachysteropexy: Lifts the uterus back into place
• Colporrhaphy: Fixes the vaginal wall in cases of cystocele or rectocele prolapse
• Ligament fixation (uterosacral or sacrospinous): Uses your tissues to fix or support the vagina or uterus

Pelvic organ prolapse is a very common and, fortunately, treatable condition. If you’re experiencing symptoms, know that you’re not alone and that a wide range of treatment options are available to help you feel better. Speaking with your healthcare provider is the first step toward relief.