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Understanding Pelvic Organ Prolapse

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Let’s be honest. The term pelvic organ prolapse (POP) can sound alarming. And the definition can sound even more alarming. It’s when organs in your pelvis (bladder, uterus, rectum, etc.) slip down from their normal position and create a bulge or sense of pressure in your vagina.

Okay, yikes. But before you freak out, it's important to know a few things. One, prolapse is very treatable. Two, it’s rarely dangerous and can often be treated with a conservative approach. And three, it’s actually pretty common.

Studies suggest that up to 50% of women have prolapse. So you probably know people affected by it — even if they don’t talk about it. (It’s not exactly “small talk.”) The fact that people don’t discuss it can make pelvic organ prolapse a concerning diagnosis, but know that you’ve already taken an important step by learning more about it. There is a lot you can do to relieve your symptoms.

So, What Does This Look Like?

Symptoms vary based on which organs are affected. But generally speaking, you might experience:

  • Heaviness or pressure in your vaginal area

  • A sensation like your tampon is falling out

  • A visible bulge in your vagina, or the sensation that a bulge is there

  • Leaking pee

  • Difficulty starting to pee or completely emptying your bladder

  • Constipation

  • Worsening symptoms with lifting, coughing, sneezing, jumping, increased activity, or symptoms that get worse by the end of the day.

Symptoms can vary a lot from person to person. And the severity of symptoms does not necessarily correlate with the severity of prolapse. Some people don’t experience any symptoms at all.

Am I at Risk?

Prolapse can affect anyone, but pregnancy and childbirth are two of the biggest contributors because they can weaken pelvic floor muscles. Other risk factors include:

  • Menopause and aging

  • Obesity

  • Smoking

  • Hysterectomy (due to weakness of pelvic muscles and connective tissue)

  • Chronic constipation

  • Excessive coughing or sneezing due to chronic conditions

  • Long-term participation in high-impact sports

  • Compromised running form

  • Connective tissue conditions, such as Marfan syndrome and Ehlers-Danlos syndrome

Tell Me More

Treatment for prolapse depends on its severity and impact on your quality of life. Pelvic floor exercises are a mainstay of treatment. In milder cases, they may be the only treatment needed. Other treatment options include:

Pelvic floor physical therapy. Refer to our All About Kegels and Exercises for Pelvic Organ Prolapse handouts for more information on this.

Vaginal pessaries. This is a flexible silicone, removable device you insert in your vagina. It helps hold your pelvic organs in place. There are many different shapes and sizes. You can be fitted for one by your doctor or purchase an over-the-counter option online or from a drug store. Some people use these all the time and some use them only during exercise or activities that worsen symptoms.

Hormone treatment. Prescription estrogen creams can help with thinning of vaginal or pelvic tissues that often occurs during menopause. These creams may help to reduce symptoms of prolapse and may help improve the effectiveness of other treatments.

Dietary changes. Increasing fiber in your diet (whole grains, fruits and veggies, and beans) may help constipation, which is a risk factor for prolapse. If it’s recommended by your provider, weight loss may also help improve symptoms as part of an overall treatment plan.

Surgery. If you’ve tried a few treatments but continue to have symptoms, you might be a candidate for surgery. Several procedures can help with prolapse. A urogynecologist — a specialist trained in gynecology and urology — can advise whether surgery is right for you.

Key Takeaways

  1. Pelvic organ prolapse occurs when pelvic organs shift into your vagina.

  2. Symptoms associated with prolapse are not necessarily correlated to the severity of your condition.

  3. Prolapse is rarely dangerous and often can be treated with a few lifestyle changes and targeted exercise therapy.

References

  1. Barber, M. D. & Maher, C. (2013). Epidemiology and outcome assessment of pelvic organ prolapse. International Urogynecology Journal, 24(11):1783-90. doi: 10.1007/s00192-013-2169-9

  2. Weintraub, A. Y., Glinter, H., & Marcus-Braun, N. (2020). Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. International Brazilian Journal of Urology, 46(1). doi: 10.1590/S1677-5538.IBJU.2018.0581

  3. Iglesia, C. B. & Smithling, K. R. (2017). Pelvic Organ Prolapse. American Family Physician, 96(3): 179-185.

  4. Pelvic organ prolapse. (2017, October 20). NHS. https://www.nhs.uk/conditions/pelvic-organ-prolapse/#:~:text=Pelvic%20organ%20prolapse%20is%20when

  5. Marijke, C., Slieker-ten Hove, M. A., Pool-Goudzwaard, A. L., Eijkemans, M. J. C., Steegers-Theunissen, R. P. M., Burger, C. W., & Vierhout, M. E. (2009). Symptomatic pelvic organ prolapse and possible risk factors in a general population. American Journal of Obstetrics and Gynecology, 200(2), 184.e1-184.e7. doi: 10.1016/j.ajog.2008.08.070

  6. Pelvic Organ Prolapse: What is Pelvic Organ Prolapse? Pelvic Organ Prolapse Symptoms, Treatment, Diagnosis - UCLA. (n.d.). UCLA Health. https://www.uclahealth.org/womens-pelvic-health/pelvic-organ-prolapse

  7. J. M. van Geelen & P. L. Dwyer. (2013). Where to for pelvic organ prolapse treatment after the FDA pronouncements? International Urogynecology Journal, 24, 707–718. doi: 10.1007/s00192-012-2025-3

  8. Pelvic Organ Prolapse (POP): Surgical Mesh Considerations and Recommendations. (2019). United States Food and Drug Administration. https://www.fda.gov/medical-devices/urogynecologic-surgical-mesh-implants/pelvic-organ-prolapse-pop#:~:text=Pelvic%20organ%20prolapse%20(POP)%20occurs