What is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the normal support of the vagina is lost, resulting in dropping of the bladder, urethra, cervix and/or rectum. It may be considered a type of hernia in which the pelvic organs descend or shift within the pelvis, and can then protrude outside the vagina. 

It is difficult to gauge exactly how many women are affected by this condition, because many of them do not ever seek medical treatment. Latest research shows that an estimated 3.3 million woman in the US have pelvic organ prolapse. It is estimated that nearly 50% of all women between the ages of 50 and 79 have some form of prolapse. By age 80, more than 1 in every 10 women will have undergone surgery for prolapse.

What Causes This?

Pelvic support comes from pelvic floor muscles and connective tissue and ligaments. When pelvic floor muscles are weakened, the connective tissue and ligaments have to provide the majority of the support. This can lead to further weakness and ultimately allowing pelvic organs to drop and press into the vaginal wall. Other risk factors include:

  • Pelvic Floor Injury: Vaginal delivery, Surgery, Pelvic radiation, back/pelvic fractures, Hysterectomy
  • Chronic Straining with Bowel Movements
  • Smoking
  • Chronic Coughing
  • Repetitive Heavy Lifting
  • Obesity

Pregnancy & Prolapse

Changes in connective tissue during pregnancy, pressure and weight of the uterus on the pelvic floor, weight gain of the mother, trauma to the pelvic floor during vaginal delivery, abdominal straining during labor and ensuing nerve damage all promote prolapse.

Symptoms

The first symptoms are often subtle, such as an inability to keep a tampon inside the vagina, some incontinence, or discomfort during intercourse. 

Signs of worsening symptoms include:

  • A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements 
  • Feeling of incomplete emptying during bowel movements 
  • Difficulty starting to urinate 
  • Urinary frequency

The Four Main Types of Prolapse

  • Cyctocele: The wall between the bladder and vagina weakens. The bladder falls down in to the vaginal cavity.

  • Uterine Prolapse: The uterine wall slides down into the vagina.

  • Rectocele: Part of the rectal wall may protrude into the vagina

  • Enterocele: Small bowel herniates into the vaginal wall. Usually occurs in women who have had a hysterectomy.

Conservative Treatment Options

Pelvic health rehab, a conservative treatment option, can be a first option for pelvic organ prolapse. Pelvic health rehab is most effective in early stages of pelvic organ prolapse. 

Treatment interventions may include:

  • Muscle re-education and strengthening
  • Functional activities of daily living alternatives
  • Bowel and bladder training
  • Postural education
  • Soft tissue mobilization
  • Biofeedback

For more information on preventing pelvic organ prolapse visit the Voice for Pelvic Floor Disorders web site.