Pelvic organ prolapse also known as POP is a condition where one or more of the pelvic organs—such as the bladder, uterus, or rectum—descend from their normal position and into the vaginal canal. A POP can be very distressing and usually occurs in women. It is usually accompanied by symptoms of pelvic pressure, heaviness, pain with intercourse, bowel dysfunction and most commonly, urinary incontinence.
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when the muscles and tissues that support the pelvic organs weaken or stretch, the effects of gravity cause the organs to shift from their normal position and bulge into the vaginal canal, which is a potential space. There are varying types of prolapse
- Cystocele: When the bladder prolapses
- Uterine prolapse: When the uterus or cervix prolapses
- Rectocele: The rectum may prolapses
- Enterocele: In some cases, the small intestine may also prolapse
Pelvic organ prolapse are graded on different levels of severity using the POP-Q system:
- Stage 0: No prolapse
- Stage 1: Prolapse is > 1 cm above the hymen
- Stage 2: Prolapse is between 1 cm above and 1 cm below hymen
- Stage 3: Prolapse is < 1 cm below hymen
- Stage 4: The vagina is completely prolapsed
The following are the most common causes and risk factors for POP:
1. Childbirth and Pregnancy
Childbirth, particularly vaginal delivery, is one of the most significant risk factors for pelvic organ prolapse. The process of labor and delivery stretches and sometimes tears the pelvic floor muscles and ligaments. Over time, this can cause the muscles to weaken, making it harder for them to provide the necessary support to the pelvic organs. Women who have had multiple children, large babies, or traumatic deliveries (e.g., forceps-assisted deliveries, lengthened time pushing) are at higher risk.
2. Age and Menopause
As women age, the pelvic floor muscles naturally weaken, and hormonal changes during menopause (such as a decrease in estrogen levels) can further contribute to this weakening. In addition the effects of gravity overtime paired with this weakness can cause further prolapse.
3. Obesity
Being overweight or obese puts extra pressure on the pelvic floor muscles. This increased pressure over time can weaken the muscles, leading to prolapse.
4. Chronic Coughing or Straining
Chronic coughing (due to conditions like chronic obstructive pulmonary disease or asthma) and frequent straining (such as from constipation or heavy lifting) can increase intra-abdominal pressure. This pressure can weaken the pelvic floor and increase the risk of prolapse. A lot of people will experience prolapse symptoms after a long fit of coughing from illness
5. Genetic Factors
Some individuals may be genetically predisposed to weaker connective tissue, which can make them more susceptible to pelvic organ prolapse. If you have a family history of prolapse or other connective tissue disorders (like Ehlers-Danlos syndrome), you may be at higher risk.
6. Previous Pelvic Surgery
Certain surgeries, such as hysterectomy (removal of the uterus), can weaken the pelvic floor and contribute to prolapse as there are less supportive structures in place.
7. Other Health Conditions
Chronic conditions that affect the muscles or connective tissue, such as neurological disorders (e.g., multiple sclerosis or Parkinson’s disease) or connective tissue disorders, can contribute to pelvic organ prolapse. These conditions may affect the strength and function of the pelvic floor muscles and tissues.
Symptoms of Pelvic Organ Prolapse
The symptoms of POP vary greatly, however there are a general number of symptoms that you may experience:
- Pelvic Pressure or Heaviness: A feeling of fullness or heaviness in the pelvic area, as if something is “falling out.” This can be worsened doing jumping activities like on a trampoline or jumping jacks.
- Visible Bulge: In more severe cases, a bulge may be visible at the vaginal opening, which may become more pronounced when standing, coughing, or bearing down. A lot of times people will notice this in the shower.
- Urinary Issues: These can include frequent urination, urinary incontinence (leakage of urine), difficulty emptying the bladder, or urinary retention.
- Bowel Problems: This can include constipation, difficulty emptying the bowels, or the feeling of incomplete evacuation.
- Pain During Intercourse (Dyspareunia): A sensation of vaginal pressure or discomfort during sexual activity.
- Back or Abdominal Pain: Some women experience chronic lower back pain or abdominal discomfort due to the pressure on pelvic organs.
- Vaginal Discomfort: This can include vaginal dryness, irritation, or even an uncomfortable bulge inside the vagina
- NO symptoms: In some cases, women may experience no noticeable symptoms, and the prolapse is discovered during a routine gynecological examination.
Diagnosing Pelvic Organ Prolapse
If you experience any of the symptoms associated with pelvic organ prolapse, it is important to see a healthcare provider for an evaluation. You can see your doctor or a physiotherapist with a special interest in pelvic floor. Pelvic floor physiotherapists are unable to diagnose and grade your prolapse, however they are able to determine your severity and recommend a gynecological visit if the POP is more severe.
Treatment Options for Pelvic Organ Prolapse
Treatment for pelvic organ prolapse depends on the severity of the prolapse, the symptoms, and the individual’s overall health and lifestyle. There are both non-surgical and surgical options available, but normally always the treatment process beings with Pelvic Floor Exercise!
1. Pelvic Floor Exercises (Kegel Exercises)
These exercises are prescribed in more mild to moderate cases, and have been known to stop the progression and even lead to improvements of the POP.. Kegel exercises involve strengthening the pelvic floor muscles, which can help provide better support for the pelvic organs and alleviate symptoms like pelvic pressure and incontinence. A pelvic floor physiotherapist can help guide you through the proper technique for performing Kegels and other strengthening exercises.
2. Pessaries
A pessary is a silicone device that is inserted into the vagina to support the prolapsed organs and prevent further descent. Pelvic floor physiotherapists in Manitoba are not allowed to fit for pessaries and this requires a visit to a gynecologist.
3. Lifestyle Modifications
Certain lifestyle changes can help manage symptoms of pelvic organ prolapse. Losing weight, managing constipation, avoiding heavy lifting or jumping, treatment of chronic cough to name a few
4. Surgery
In more severe cases of pelvic organ prolapse, surgery may be required to correct the condition. Surgical options include:
- Anterior or posterior repair: Surgery to repair a cystocele (bladder prolapse) or rectocele (rectal prolapse).
- Hysterectomy: Removal of the uterus in cases of uterine prolapse.
- Pelvic floor reconstruction: Reconstructing and reinforcing the pelvic floor muscles and ligaments using sutures or mesh to provide better support for the organs.
Surgical treatment is typically considered if the prolapse is more severe and when first line treatments ie: pelvic floor exercises have not improved the condition.
Conclusion
Pelvic organ prolapse is a common condition, affecting almost 50% of women at some point in their lifetime. It can be a very distressing condition, however the sooner you get help the sooner you can start seeing results and living life to its fullest! We have two physiotherapists on our team certified in pelvic floor, ready to help!