The Facts on Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a type of pelvic floor disorder that can cause painful and unpleasant symptoms for women, including dyspareunia, which is painful sex. It is estimated that about one-third of all women experience a pelvic floor disorder at some point in their lives, ranging from urinary or fecal incontinence (leaking of urine or stool, respectively) to POP. Here are the facts on pelvic organ prolapse.

What is pelvic organ prolapse?

Pelvic organ prolapse is a condition in which at least one of the pelvic organs descends or “falls” from its normal position into or outside of the vagina.

Which pelvic organs could be affected?

A woman with POP may experience the prolapse or descent/displacement of any of the following pelvic organs:

• Bladder (a prolapse called cystocele)
• Uterus (uterine prolapse)
• Small bowel (enterocele)
• Rectum (rectocele)

Even the vagina itself can prolapse when the upper portion loses its shape and descends into the vaginal canal. This is called vaginal vault prolapse.

What causes pelvic organ prolapse?

Like other pelvic floor disorders, pelvic organ prolapse occurs when the muscles, connective tissues, and nerves of a woman’s pelvic floor do not function as well as they should.

Normally, these muscles and connective tissues support the pelvic organs and hold them in place, but increased pressure on the abdomen can weaken the pelvic floor muscles and lead to disorders such as POP. Some of the most common causes of pelvic organ prolapse are as follows:

• Pregnancy, labor, and childbirth (these are the most common causes)
• Obesity
• Constipation
• Pelvic organ cancers
• Hysterectomy (the removal of the uterus by surgery)
• Chronic cough, which puts stress on the pelvic floor muscles
• Aging (pelvic floor disorders are more common in older women)
• Genetics (women predisposed to weakened pelvic floor muscles may be more prone to POP)

What are the symptoms?

Women with mild cases of pelvic organ prolapse may not notice any changes or issues with their bodies. However, other POP patients report the following symptoms:

• Feeling or seeing a bulge in the vagina
• Feeling like something is falling out of the vagina
• Painful intercourse (dyspareunia)
• Low back pain or aches
• Feeling pressure, discomfort, or fullness in the pelvic area
• Urinary incontinence or leaking
• Constipation
• Vaginal bleeding or spotting
• Vulvar pain or discomfort during some physical exercise activities

A woman’s symptoms are likely to vary depending on the severity of her case and the organ that has prolapsed. For instance, if a woman’s bladder has prolapsed, she may experience leaking urine and/or the feeling of constantly needing to urinate. Alternatively, if her rectum has prolapsed, she may become constipated and find intercourse painful.

How is pelvic organ prolapse diagnosed?

Anyone whose life has been impacted by one or more of these symptoms should consult with her healthcare provider. Often, a physician can identify pelvic organ prolapse during a routine pelvic exam. However, additional tests may be required to diagnose POP, including urinary tract X-rays and CT scans, ultrasounds, or MRI scans of the pelvis.

How is it treated?

For mild cases of pelvic organ prolapse, a doctor may recommend pelvic floor exercises (Kegels, etc.) to strengthen the muscles of the pelvic floor. It is important to perform pelvic floor exercises correctly and consistently to get the desired results, so enlisting the help of a physical therapist is recommended.

In more severe cases, POP may be treated by surgery to repair the prolapse and reinforce the pelvic floor, surgery to remove the offending organ (i.e. a hysterectomy for a prolapsed uterus), or the insertion of a small plastic device called a pessary into the vagina to support the prolapsed organ.

Can it be prevented? How?

While some of the causes of pelvic organ prolapse are beyond one’s control, a woman can take steps to reduce her risk of developing POP. Experts recommend that women do daily Kegel exercises, maintain a healthy body weight, avoid constipation by eating fiber-rich foods, and quit smoking to support a healthy pelvic floor.

Resources:

Giannelli, J. (2020, April 28). Painful Sex: Is Pelvic Organ Prolapse the Cause? Maze Women’s Sexual Health. https://www.mazewomenshealth.com/blog/2020/04/28/painful-sex-is-pelvic-organ-prolapse-the-cause/

The Office on Women’s Health. (2019, May 14). Pelvic Organ Prolapse. https://www.womenshealth.gov/a-z-topics/pelvic-organ-prolapse

WebMD. (2021). Pelvic Organ Prolapse. https://www.webmd.com/urinary-incontinence-oab/pelvic-organ-prolapse