You & Your Pelvic Floor: Let's Talk About Pelvic Organ Prolapse
January 05, 2021
Pelvic organ prolapse (aka POP) is a pelvic floor disorder that can sound scary, especially if you’re not familiar with what it entails. And that is reasonable -- it’s a serious condition that should be taken seriously.
But while it’s not fun for anyone to experience, many women are too embarrassed to talk (or learn) about their symptoms, or how to deal with them (even with their healthcare provider). Sometimes, people even think that POP is normal or inevitable, for example as a consequence of childbirth or other life experiences. But, as with many pelvic health issues, POP is both treatable and an important quality of life driver, and that kind of thinking is doing themselves a disservice.
In this article, we’ll be presenting an overview of pelvic organ prolapse, including symptoms to watch out for and best practices for dealing with it.
What is pelvic organ prolapse?
POP is a type of pelvic floor dysfunction that occurs when the pelvic organs drop lower in the pelvis than they are supposed to be. This applies pressure to and creates a bulge in the vagina, which is called a prolapse. There are a few specific types, depending on which pelvic organs are out of place:
- Cystocele: this is when the bladder protrudes into the vagina. It's the most common form of prolapse.
- Urethrocele: this is when the tissues surrounding the urethra sag downward into the vagina.
- Rectocele: this is when the rectum bulges into the back wall of the vagina.
- Uterine prolapse: this is when the uterus drops into the vagina.
POP is typically developed in the years after childbirth, hysterectomy or menopause. And it’s way more common than you may think.
This study estimated that as many as 5% of women in the United States may experience it, and other researchers have forecasted increased prevalence in the coming decades (up to nearly 8%) as the US population continues to age.
Women with POP may experience a feeling of pressure in the vaginal area, as well as any of a variety of pelvic floor issues associated with challenges around bladder control, pelvic pain, sexual function and body image.
The study linked in the introduction to this article calls POP “a disease of silence and shame” and notes that many sufferers don’t realize that it is a common problem. This lack of knowledge often leads to feelings of shame, inability to communicate the problems, embarrassment, fear, and difficulty coping with the symptoms.
Symptoms of pelvic organ prolapseSo, what are the symptoms? The general sensation is sometimes reported as a feeling of heaviness in your lower abdomen and genitals. Or it is also sometimes described as a dragging discomfort inside the vagina, or a feeling like something is coming down into the vagina. Other specific symptoms can include:
- Pelvic pain and/or lower back pain
- Bladder leakage / any form of urinary incontinence
- Painful sex
- Urinary tract infections
What causes pelvic organ prolapse?
The direct cause is that the muscles, ligaments and connective tissue supporting your pelvic organs in their proper positions have weakened. This is often caused by pregnancy (and vaginal delivery), which can stretch and weaken the pelvic floor. As if there isn’t enough on the mind in the postpartum period...
Other risk factors can include aging, weight gain or obesity, and chronic coughing -- any of these can contribute to weakening of the pelvic floor and increase the risk of POP.
How can I try to avoid pelvic organ prolapse?
Short answer: Kegel exercise!
Slightly longer answer: POP is generally caused by weakened pelvic floor muscles. Fortunately, it is well-established that pelvic floor muscle strengthening (aka Kegel exercise) can be effective at helping build the strength and endurance of your pelvic floor.
Furthermore, certain lifestyle changes such as quitting smoking, dietary changes, or weight management can also reduce the risk of POP.
How can I treat pelvic organ prolapse if I already have it?
First of all, you should be talking to your healthcare provider such as a doctor and/or pelvic floor physical therapist. But in terms of understanding the potential landscape, there are a number of possible treatment options that your clinician may wish to pursue for women who already have a prolapse.
The preventative measures described above (pelvic floor exercise and/or other physical therapy and potential lifestyle changes) can also help if prolapse is occurring and are usually the best place to start, given that they have such a low risk of negative side effects.
Another option sometimes used is a pessary that is inserted into the vagina to support the organs that have moved downwards. They are often made from silicone and can come in a variety of different shapes. Generally speaking they are custom-fitted and are removable.
Finally, surgery is another possible route. It is usually considered for women who have tried more conservative options like pelvic floor exercise and found that they weren’t effective for them.