Pelvic Organ Prolapse

There are awkward conditions, and then there is pelvic organ prolapse. It is uncomfortable, upsetting and embarrassing.

With pelvic organ prolapse (POP), there is a bulge at the opening of your vagina, which occurs because one or more of your pelvic organs has slipped or dropped down from their normal position. The organ can be your womb (uterus), bladder, bowel or the top of your vagina.

How does pelvic organ prolapse occur?

Well, usually, the pelvic organs—the uterus, vagina, bladder, and rectum—are propped and held in place by the muscles and tissues of the pelvic floor. But when these muscles weaken, the pelvic organs drop downwards into or out of the vagina.

While not a life-threatening or dangerous condition, pelvic organ prolapse is painful and distracting. When the prolapse pulls your bladder downward, it bends the ureter and causes trouble urinating fully. It can also pull your rectum downward and cause constipation.

The symptoms of pelvic organ prolapse include:

1. An uncomfortable bulge in the vagina
2. Feeling like something is coming down your vagina—it may feel like sitting on a small ball
3. A dragging discomfort inside your vagina
4. Pressure, discomfort, aching or pain in the lower back, pelvis, or both
5. A feeling of fullness or heaviness around your lower tummy and genitals
6. Pelvic pressure that gets worse when you cough or stand
7. Numbness or discomfort during sex
8. Uncomfortable pressure during sex or physical activity
9. Constipation
10. Urinary problems, such as urine leakage or urinary frequency
11. Problems inserting tampons

Types of pelvic organ prolapse

1. Cystocele
   This type of pelvic organ prolapse occurs when the bladder protrudes into the vagina and creates a bulge. It is the most frequent form of prolapse.
2. Uterine prolapse
   When the uterus drops into the vagina, it leads to a bulge at the vaginal opening.
3. Rectocele
   This happens when the rectum bulges into the back wall of the vagina.
4. Posterior wall prolapse
   This form of pelvic organ prolapse occurs when the bowel bulges forward into the wall of the vagina resulting in a bulge at the vaginal opening.
5. Vaginal sag
   This form occurs when the top of the vagina sags down. It is seen in some women after surgery to remove the uterus.

What are the causes of pelvic organ prolapse?

The connective tissues and muscles of your pelvis may not work as well after pregnancy and vaginal childbirth, especially after a long and difficult labor. They may also weaken if you gave birth to a large newborn or multiple babies.

The baby’s head going through the vaginal canal can stretch and weaken the muscles and connective tissues. With multiple vaginal childbirths, the pelvic floor gets more stretched and more strained, which can result in pelvic organ prolapse. However, you can still have POP following a cesarean or C-section delivery.

You may also experience pelvic organ prolapse after long-term pressure on your abdomen, including pressure from chronic coughing, obesity, or straining often during bowel movements. Other causes of POP include aging, giving birth to a baby weighing more than eight pounds, being overweight, hormonal changes during menopause, and having hysterectomy.

Other risk factors for POP include family history, a job requiring lots of heavy lifting, having long-term constipation, and having a long-term condition that involves frequent coughing and strain which increases pressure in the abdomen and pelvis.

How is pelvic organ prolapse treated?

The type of treatment offered for pelvic organ prolapse depends on the form of prolapse and the severity. As a first line treatment, your female pelvic medicine and reconstructive surgery (FPMRS) physician may recommend pelvic floor therapy. That is, you perform Kegel exercises to squeeze and release the muscles in order to strengthen them and improve support for your pelvic organs.

Alternatively, your urogynecologist may prescribe a pessary, which is a silicone-based device inserted into the vagina to support the prolapsed organs. The pessary is custom-fitted and removable. But if the pessary is uncomfortable or not helping, your FPMRS physician may recommend surgery. For example, you may undergo a hysterectomy if you have uterine prolapse or sacrocolpopexy if you are at high risk of repeated prolapse.

Seek timely treatment

While pelvic organ prolapse is an embarrassing condition to talk about, it is something you really should discuss with a urogynecologist as soon as possible. Letting it go untreated will allow urine to be retained in your bladder, resulting in chronic urinary tract infections.

At Advanced Urology Institute, we encourage women to seek timely treatment for pelvic organ prolapse. Our knowledgeable and experienced urogynecologists encourage frank and open consultations, which ensure proper diagnosis.

And our treatments are tailored to suit the needs of every patient. Which means you can rest assured that you will receive appropriate treatment and recover from your condition. For more information on pelvic floor disorders, female pelvic medicine and reconstructive surgery, visit the Advanced Urology Institute website.