Pelvic organ prolapse (POP) happens when your pelvic floor muscles and ligaments weaken, often after pregnancy and childbirth, causing one or more of your pelvic organs to drop into your vagina. POP can be so mild that you don’t realize you have it or so severe that an organ is bulging into or out of your vagina. If your prolapse or other pelvic floor symptoms – such as incontinence, pressure, or painful sex – are bothersome, your healthcare provider can refer you to a urogynecologist or pelvic floor therapist for treatment. You can also take steps, such as losing weight and avoiding constipation, to reduce your risk of new or worsening pelvic organ prolapse.
IN THIS ARTICLE
- What is pelvic organ prolapse?
- What are the symptoms of pelvic organ prolapse?
- What are the stages of pelvic organ prolapse?
- What causes prolapse after childbirth?
- What is the treatment for pelvic organ prolapse?
- Is there anything I can do to help with or prevent pelvic organ prolapse?
- Can uterine prolapse and other types of prolapse affect future births?
What is pelvic organ prolapse?
Pelvic organ prolapse (POP) happens when one or more of your pelvic organs drops down from its normal position and bulges into your vagina. These organs include the vagina, cervix, uterus, bladder, urethra, small intestine, and rectum. POP happens when the pelvic floor – the muscles, ligaments, and tissues that hold the organs in place – is weakened.
There are different degrees of POP. Sometimes the organ drops a little bit, while other times it descends until it’s protruding from – or completely out of – your vagina.
Pelvic organ prolapse usually (but not always) happens after pregnancy and childbirth, and it affects 1 in 4 of women in their 40s, 1 in 3 women in their 60s, and half of all women in their 80s. There are different types of pelvic organ prolapse, and it’s important that your healthcare provider identifies the prolapse you have in order to get the right treatment.
The different types of pelvic organ prolapse are:
- Prolapsed bladder. Also called a cystocele or anterior compartment prolapse, this is when the bladder prolapses into the front wall of the vagina.
- Posterior vaginal wall prolapse. Also called a rectocele, this is when the bowel prolapses into the back wall of the vagina.
- Prolapsed intestines. Also called enterocele, this happens when the small bowel bulges through a space between the vagina and rectum.
- Prolapsed uterus. Also called uterine prolapse. This happens when the cervix and uterus move down toward or into the vagina. If you’ve had a hysterectomy, the top of the vagina can also prolapse.
What are the symptoms of pelvic organ prolapse?
Most women don’t have symptoms and may actually find out that they have a prolapse during a routine pelvic exam. But if a prolapsed organ pushes into other organs, it can cause symptoms or issues. In some instances, the organ may bulge out of your vagina (which you can feel, or even see), if it descends that far.
If you do have symptoms, they might include:
- A vaginal bulge, or feeling pelvic pressure or fullness
- Urinary incontinence or not being able to empty the bladder completely
- Bowel incontinence or problems having a bowel movement
- Back pressure or lower back pain
- Painful sex
- Feeling of looseness in the vagina
- Feeling like you have to push on your vagina in order to empty your bladder or bowels
- Problems inserting or keeping in tampons or applicators
What are the stages of pelvic organ prolapse?
Pelvic organ prolapse is categorized according to how much the organ(s) has descended.
The pelvic organ prolapse stages are:
- Stage 0. The pelvic organs are well supported by the ligaments, and there’s no prolapse.
- Stage 1. The organs are still pretty well supported, so the prolapse is mild. The organ has just begun to drop into the vagina.
- Stage 2. The organs are within 1 centimeter of your vaginal opening.
- Stage 3. The pelvic floor organs have descended and are protruding more than 1 centimeter beyond the opening of the vagina.
- Stage 4. Organs have fallen completely through the vaginal opening. This severe stage is called procidentia.
What causes prolapse after childbirth?
Pregnancy and childbirth – which can stretch and weaken the pelvic floor – are the most common causes of POP. During pregnancy, your body produces the hormone relaxin, which softens your ligaments and tissues – including those in the pelvic floor. At the same time, as your pregnancy progresses and your baby grows, your pelvic floor muscles are stretched and taxed as they support more and more weight.
To top it off, the pushing and stretching of childbirth can put additional strain on your pelvic floor and pelvic organs. In fact, vaginal birth doubles the rate of pelvic floor disorders compared to a cesarean delivery or not giving birth. Your risk of pelvic organ prolapse is further increased if you push for a long time during labor or have a large baby or an assisted birth. Your risk for POP also increases with the more children you give birth to.
Other causes of pelvic organ prolapse include aging, genetics, menopause, obesity, chronic constipation, chronic coughing, repeated heavy lifting, pelvic floor injuries, and diseases that weaken connective tissue (such as diabetes, Parkinson’s disease, and stroke).
What is the treatment for pelvic organ prolapse?
Many women don’t need treatment for POP. If you do (because you have bothersome symptoms), the choice of treatment will depend on the severity of your POP and the symptoms it’s causing. Treatment doesn’t always completely correct the problem, but it can improve the symptoms. Your healthcare provider can refer you to work with a pelvic floor specialist or a urogynecologist to develop the right treatment plan.
Treatment options include:
Pelvic floor therapy
During pelvic floor therapy, a physical therapist can help you identify and practice exercises to both strengthen and relax your pelvic floor muscles. They may use biofeedback to help you identify which muscles you need to target. Doing Kegels may be helpful, but you need to make sure you’re doing them correctly, or they can do more harm than good. Your pelvic floor therapist can make sure you’re doing them right.
A pessary
A pessary is a device that fits inside your vagina and helps support your pelvic organs. Your healthcare provider will fit you with the correct pessary for your body and your needs. (They come in different sizes and shapes.)
Surgery
The type of surgery you need will depend on which organ(s) are prolapsed and how severe your condition is. The surgery may be done abdominally, transvaginally, or with a scope through the belly button. Surgery may be done to repair organs or move organs back to their proper locations. If you have uterine prolapse, there’s a chance a hysterectomy may be recommended.
Surgery isn’t always a permanent solution (there’s a 30 percent recurrence rate), and it isn’t recommended for women planning to have children in the future. Occasionally the vagina is surgically closed by making it very short and tight, which creates support for prolapsed organs (this procedure is called colpocleiesis).
Up until 2019, surgical mesh had been used to provide support in the surgical treatment of POP, but because of safety concerns, the FDA ordered that surgical mesh products placed vaginally for the repair of POP no longer be sold or distributed. (Surgical mesh for other uses is still considered safe and is routinely used.)
Estrogen
Your healthcare provider may recommend topical estrogen for strengthening the vaginal wall. There are topical creams, suppository tablets, and a vaginal ring (which slowly releases estrogen over several months).
One important thing to note: Healthcare professionals will recommend that you avoid any procedures promoted as “vaginal rejuvenation” to treat POP. Pelvic organ prolapse is a medical condition, not a cosmetic one. These procedures won’t help and may even be harmful.
Is there anything I can do to help with or prevent pelvic organ prolapse?
There are steps you can take on your own to improve and reduce your risk of POP:
- Try to lose weight, if you’re overweight, to take some pressure off your pelvic organs
- Quit smoking and seek treatment for a chronic cough
- Do exercises – such as yoga and Pilates – to help build your core strength
- Avoid constipation and straining during bowel movements. Drink plenty of water and try adding more fiber to your postpartum diet. (Ask your healthcare provider about using a stool softener if necessary.)
Can uterine prolapse and other types of prolapse affect future births?
Most mild pelvic organ prolapse is unlikely to affect your fertility or your ability to carry and deliver your baby in the future. If you have a severe prolapse, however, you may need treatment before becoming pregnant and carrying a pregnancy. It’s a good idea to treat your prolapse – so you can regain strength in your pelvic floor – before becoming pregnant.
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