What is Prolapse?
Pelvic Organ Prolapse (POP) is a common condition when the uterus, bladder, or rectum (or other tissues and organs) drop from their normal position into or out of your vagina. POP is a pelvic floor disorder affecting about 3% of women in the U.S.1 though they often suffer in silence due to embarrassment and lack of support from their friends or family as the symptoms are not visible to others.
Unfortunately, while POP may cause physical discomfort, it may also impact our sex lives, body images, and our quality of life.2,3 Bringing more awareness to this condition may help more women will feel comfortable enough to seek the care they need. Below, you will find information that should be helpful if you suspect that you, or someone you know, may have or be at risk for POP.
How Does Prolapse Happen?
Three of the main organs in the pelvic floor are the uterus (holds babies for reproduction), bladder (stores urine before peeing) and the rectum (stores feces before elimination). Normally, those organs are kept in place by tissues and muscles to ensure they maintain proper function. Think of your bladder as a water bottle. It needs to be held upright vs on its side to allow for the water to pour out properly. When tissues and muscles become weak, these organs begin to slip down and lose position. Pelvic organ prolapse occurs when the muscles and tissues are no longer capable of supporting pelvic organs and they descend or protrude out of the vaginal opening.4–6
What Are the Symptoms of Prolapse?
Most women who are in early stages of POP will have few symptoms, the most common symptom they detect, is a bulge at the opening of the vagina – which they can see and/or feel.7 Other symptoms women may experience include those related to the bladder and bowel, such as incontinence, constipation, or difficulty urinating.4 Women with POP can also experience pelvic or back pain, abnormal sensations of pressure,5or difficulties inserting tampons21.
What are the causes and risk factors associated with prolapse?
As a woman, your likelihood of experiencing POP increases as you get older. Approximately 37% of women with pelvic floor disorders are between 60 and 79 years old, this number increases to 50% once we look at women who are 80 or older.8
While age increases the risk for prolapse for a large portion of a women, pregnancy is the most common risk factor leading to POP. Prolapse often occurs several years after childbirth, and vaginal childbirth is more likely to lead to prolapse than cesarean section birth.5,9
In addition to pregnancy, higher body mass index (BMI) also increases the risk for pelvic organ prolapse5 from long-term pressure on your pelvis. While gaining weight may create the problem, unfortunately, losing weight is not considered an effective way to reverse it10, but losing weight may decrease some symptoms.
Some other risk factors for prolapse are chronic coughing, straining during bowel movements (chronic constipation), and hysterectomies4,8.
When should you see a doctor, and who should you see?
You should see a physician if you are experiencing symptoms, because delaying the diagnosis can limit your treatment options. If you suspect that you have POP, your primary care physician can assess your symptoms and determine if you should be referred to a gynecologic sub-specialist. 5
How is pelvic organ prolapse diagnosed and treated?
If your doctor thinks you may be suffering from POP, they will conduct a pelvic examination to determine the precise location of the prolapse as well as its extent or severity.5
The examination will begin by looking at the opening of your vagina as well as an area known as the perineal body (area between the vagina and anus) while having you do a breathing exercise known as the Valsalva maneuver.5 This technique requires you to hold your breath then push (like having a bowel movement).22 Your doctor can use a speculum to visualize your cervix and vagina and can take measurements to determine if prolapse is present. They may also perform a rectal examination to determine if there is a rectal bulge.
There are several different options for treating pelvic organ prolapse, which range from nothing, non-invasive, and surgical interventions. If you have POP, the treatment that your doctor will suggest will depend on the nature of the prolapse and – most importantly – your preferences.5,11
- Noninvasive approaches. Noninvasive technique like pelvic floor muscle exercises, such as performing Kegel exercises, can improve the symptoms and slow the progression, but it usually does not reverse the prolapse itself. 12
- Pessaries. Pessaries are popular devices that are placed into the vagina to help overcome symptoms and hopefully improve prolapse and/or continence through anatomical restoration. They are popular options for patients who have not finished having children, do not desire surgery, or are poor surgical candidates23. About two-thirds of patients choose a pessary as an initial strategy for managing their condition. When asked to identify their recommended first-line therapy for pelvic organ prolapse, 77% of members of the American Urogynecologic Society pointed to pessaries15. 70-80% of women find them successful enough to use beyond one year.13,14 Pessaries do require regular removal and cleaning as nearly as one-third of patients who use them experience bacterial vaginal inflammation if removed infrequently.18
- While pessaries are a popular first line treatment, patients who experience significant pelvic pain are not generally considered the best candidates for these devices.5 There are also common complications to be considered with the use of pessaries, including pain, irritation, bleeding, vaginal discharge, and odor18.
- Surgery. Patients who have a more severe cases of POP or who choose long lasting treatment options may pursue surgery. There are a few different surgical options, and the specific chosen procedure will depend on the details of the prolapse and patient preferences, including whether a woman desires to continue to engage in vaginal intercourse.5 The type of surgery you have will depend on which organs are prolapsed and will usually be performed by a Urogynecologist, gynecologist, or a urologist.
Ways to Prevent Prolapse
There are certain lifestyle changes that can help minimize pelvic organ prolapse, such as exercise and diet aimed at weight loss, reducing heavy weight lifting, and treating conditions that could lead to prolapse – such as constipation.4
As many as 50% of people with chronic constipation have pelvic floor dysfunction24, which can lead to the weakening of the pelvic floor muscles25.
Pelvic floor muscle training can strengthen the pelvic floor and help to improve symptoms. Unfortunately, research has shown that muscle training does not prevent pelvic organ prolapse altogether.19
Vaginal childbirth has twice the risk27 than cesarean sections for developing POP symptoms and some women may elect to have a C-section to decrease prolapse. However, this prevention method is controversial due to the medical risks associated with cesarean sections and the health of the mother and baby.20
Pelvic organ prolapse is more common than most women realize, and those who suspect they may suffer from this condition should talk to their healthcare provider about how to address their symptoms. Diagnosis may be determined with relative ease, and patients with the condition have several options, nonsurgical and surgical. Though several factors will determine if temporary or surgical options are best for each patient.
It is important to speak with your doctor about the specific pros and cons of the therapeutic options for helping with pelvic organ prolapse and as soon as you notice the symptoms we have discussed here.