Pelvic organ prolapse (POP)

Pelvic organ prolapse is a type of pelvic floor disorder, happening when one or more organs inside the pelvis slip (prolapse) from their normal places. These organs are considered prolapsed if they descend into the vaginal canal or anus.

Organs that make up the pelvic region

  • The small intestine.
  • The bladder.
  • The urethra.
  • The pelvic floor muscles that support organs and other structures in the pelvis.
  • The uterus (womb).
  • The vagina.
  • The rectum.

Pelvic organ prolapse is treatable

Pelvic organ prolapse, or POP, affects between 20% to 30% of people over their lifetime, usually occurring more in elderly individuals. POP is generally less common than urinary incontinence or fecal incontinence (the two other kinds of pelvic floor disorders).

It is generally not a life-threatening condition, and can be easily treated to alleviate any painful or irritating symptoms.

Types of pelvic organ prolapse

Pelvic organ prolapse is a type of pelvic floor disorder, happening when one or more organs inside the pelvis slip (prolapse) from their normal places. These organs are considered prolapsed if they descend into the vaginal canal or anus.

Types of pelvic prolapse include:

  • Cystocele (bladder prolapse).This is the most common kind of pelvic organ prolapse.
  • Enterocele (small bowel/small intestine prolapse).
  • Rectocele (rectal prolapse).
  • Urethrocele (urethral prolapse).
  • Uterine prolapse (dropped uterus).
  • Vaginal vault prolapse (genital prolapse, vaginal prolapse).

provider explaining a treatment

 

What causes pelvic organ prolapse?

Anything that puts increased pressure on the abdomen can cause your pelvic floor muscle to weaken and result in a pelvic prolapse. Weakened muscles and ligaments can also create a lack of support for the pelvic organs. There are several causes of pelvic organ prolapse including:

Provider and patient having a discussion

  • Aging and going through menopause. About 37% of menopausal individuals experience pelvic floor disorders.
  • Being overweight or obese.
  • Chronic cough (such as with bronchitis or smoking).
  • Chronic straining (such as with constipation).
  • Connective tissue disorders.
  • Heavy lifting.
  • Hereditary (genetic) factors.
  • Hysterectomy (surgical removal of the uterus).
  • Pelvic organ cancer.
  • Pregnancy, labor, and vaginal childbirth. Tearing or stretching in the supportive tissue and vaginal wall is the most common cause of pelvic organ prolapse. Giving birth to a baby weighing over 8.5 pounds also increases your risk.

Symptoms of pelvic organ prolapse

Symptoms will depend on which pelvic organ is out of place.

Not everyone experiences symptoms from a prolapse. If symptoms occur, though, they may include:

  • A feeling of fullness in the pelvic floor region or pelvic pressure.
  • A sense that a ball or lump is sticking out from your vaginal opening from uterine prolapse.
  • Constipation from rectal prolapse.
  • Leg fatigue.
  • Pain, discomfort, or numbness when having sex from small bowel, uterine, or rectocele.
  • Pain or pressure in your abdomen, groin, or low back from bowel or uterine prolapse.
  • Spotting or bleeding from the vagina from uterine or vaginal vault prolapse.
  • Urine leakage (stress urinary incontinence) when you cough or exercise from bladder prolapse.

Woman checking in for clinic visit

Always be sure to see your doctor if you are experiencing symptoms, especially if you notice a lump in or around your vagina.

Diagnosing pelvic organ prolapse

The best way to tell if you have pelvic organ prolapse is to get diagnosed by a specialist. Your doctor will start by obtaining your detailed medical history and having you take a physical exam, possibly feeling for lumps in your pelvic area or inspecting the inside of the vagina with a speculum. They can also discover a prolapsed organ during a routine pelvic exam, or a PAP smear.

Your doctor may also recommend the following tests for thorough diagnosis:

  • Urine test.
  • CT scan of the pelvis.
  • MRI of the pelvis.
  • Pelvic ultrasound.
  • Urinary tract X-ray.

How is pelvic organ prolapse treated?

There are a variety of treatment options to fix or reverse pelvic organ prolapse, depending on the cause and severity of your prolapse symptoms. In some instances, POP can go away on its own or without surgery.

The following treatments for pelvic organ prolapse may include:

Devices

Vaginal pessary. A small, plastic, removable device called a pessary is inserted into the vagina to provide support for the drooping organs and vaginal wall. A pessary can ease moderate and severe symptoms, and is the best option if surgery is not recommended.

Medication

Hormone therapy. If a mild prolapse occurs because of menopause, your doctor may recommend you take Estrogen to help strengthen your vaginal muscles and ease vaginal dryness. Estrogen hormone therapy is available as a cream applied to the vagina, or a tablet or ring that releases Estrogen inside the vaginal wall.

Exercises or therapy

Pelvic floor exercise (Kegels). These pelvic floor muscle training exercises can strengthen the tissue in your pelvic region to hold the organs in place. You will practice contracting and relaxing the muscles surrounding the urethra, vagina, and rectum.

Pelvic floor physical therapy. Your doctor will show you how to do specific exercises, or a physical therapist can do them with you to help strengthen your pelvic floor muscles. This is useful for POP and urinary incontinence.

Surgery

Vaginal surgery. This surgery is used to repair the vagina or uterus, usually recommended for people who have uterine prolapse related to a hysterectomy or who are experiencing impairment and pain from a severe prolapse.

Sacral colpopexy. This is a more intense vaginal surgery in which the vaginal opening is sewn shut. This surgery is usually only recommended for frail or elderly individuals who no longer plan to have vaginal intercourse and who have experienced severe prolapse of the vaginal vault.

Pelvic organ prolapse surgery. This surgery is used for non-gynecologic pelvic organ prolapse. During surgery, the dropped organ, usually the rectum or bladder, will be lifted and stitched into place.

Preventing pelvic organ prolapse

Some risk factors make you more likely to develop a prolapse, including family history, aging, difficulty during childbirth, or a hysterectomy. However, the likelihood of having a prolapsed organ can be dramatically reduced by the following practices:

Woman and provider looking at tablet

  • Avoid heavy lifting.
  • Do not smoke, or quit smoking to prevent chronic cough that can cause a prolapse.
  • Eat a diet high in fiber or take laxatives if necessary to reduce strain and avoid constipation.
  • Maintain a healthy weight to reduce the risk of obesity-related organ prolapse.
  • Pelvic exercises. Kegels and general exercise can help maintain pelvic muscle strength.