Understanding Pelvic Organ Prolapse
Muscles and tissues that make up the pelvic floor support the pelvic organs, including the uterus, cervix, bladder, vagina and rectum. When these structures become damaged or weak, they may no longer be able to hold the pelvic organs in place. As a result, one or more organs can drop out of position, sometimes pressing into or out of the vagina.
Pelvic organ prolapse is one of the most common types of pelvic floor disorders, along with urinary and fecal incontinence. There are several different types of prolapse, including:
- Dropped bladder: Also called cystocele, this is the most common type of pelvic organ prolapse, occurring when the bladder drops into or out of the vagina.
- Rectocele: This causes the rectum to bulge into the vaginal wall.
- Dropped uterus: Also called uterine prolapse, this happens when the uterus drops into the vagina.
It’s also possible to have more than one pelvic floor disorder simultaneously, such as pelvic organ prolapse and urinary incontinence.
Causes of Pelvic Organ Prolapse
Pelvic floor muscles and pelvic connective tissues can weaken for different reasons. Risk factors for developing pelvic organ prolapse include:
- Childbirth: Vaginal childbirth is the biggest risk factor for developing pelvic organ prolapse, as giving birth puts strain on the pelvic floor and stretches the connective tissues. Having multiple vaginal childbirths can raise the risk even more as you get older. Giving birth to a baby who weighs more than 8 ½ pounds also raises your risk.
- Long-term abdominal pressure: This can happen due to obesity, a chronic cough or constipation, which can cause you to strain during a bowel movement.
- Age: As women get older, pelvic floor disorders become more common. Nearly half of those diagnosed with pelvic organ prolapse are 80 years old or older, with another 37% between the ages of 60 and 79.
- Menopause: Levels of estrogen hormone drop during and after menopause, which can make pelvic organ prolapse more likely. Researchers are studying the connection between estrogen and pelvic organ prolapse.
- Family History: Genetics can also play a role in developing pelvic organ prolapse.
- Hysterectomy: In rare cases, a hysterectomy can cause part of the vaginal wall to drop, creating a bulge.
Symptoms to Watch For
While pelvic organ prolapse isn’t a dangerous condition, it can cause a lot of discomfort and lead to urinary tract infections if left untreated. Symptoms of pelvic organ prolapse include:
- Seeing or feeling like you have a bulge in your vagina
- Discomfort in the pelvis, such as pressure, aching or a feeling of fullness
- Pressure in the pelvis that worsens with coughing or standing for a period of time, or that becomes more noticeable as the day goes on
- Urine leakage (incontinence) or trouble having a bowel movement
- Painful sex
- Discomfort when inserting tampons
If you experience any of these symptoms, see your doctor for care. Your doctor will do a pelvic exam and may also ask you to cough or strain to determine whether this causes urine to leak or other prolapse symptoms. Your doctor may also run tests to see how well your bladder empties when you use the bathroom.
Treatment Options
After diagnosing pelvic organ prolapse, your doctor will develop a treatment plan based on the type of prolapse, symptoms and other factors such as your age and whether you are sexually active. Treatment options include:
- Vaginal pessary: This is a plastic or silicone device that is inserted into the vagina and supports pelvic organs. In many cases, this is the first type of treatment doctors try to treat prolapse, and it can also help with urinary incontinence.
- Pelvic floor muscle physical therapy: Certain exercises can help strengthen the pelvic floor. Your doctor might refer you to a physical therapist, who can show you how to do pelvic floor exercises such as Kegels, which involve squeezing as if you were holding in urine and then releasing.
- Diet changes: Your doctor may direct you to eat a fiber-filled diet to regulate bowel habits and help prevent straining during bowel movements.
- Surgery to support the vagina or uterus: In this type of surgery, the surgeon strengthens support of the pelvic floor by using synthetic mesh or your own body tissue. Sexually active women often have this type of treatment, which can be done through the abdomen or the vagina, depending on the type of procedure.
- Surgical closure of the vagina: This involves a procedure called colpocleisis. This option can be used for women who no longer have vaginal intercourse.
Lifestyle Changes and Prevention
Although researchers are still studying ways women can prevent pelvic organ prolapse, making certain lifestyle changes can help reduce your risk. These include:
- Reaching or maintaining a healthy weight: Because women who are overweight or obese are at higher risk of developing pelvic floor disorders, losing weight or staying at a healthy weight can help prevent problems from occurring.
- Eating fiber-filled foods: Eating a diet rich in fiber can help prevent constipation, which in turn helps reduce straining during bowel movements, lessening the risk of developing pelvic organ prolapse.
- Not smoking: Many people who smoke develop a chronic cough, which strains pelvic floor muscles. Giving up smoking (or not starting if you’re already a nonsmoker) is another way to help prevent pelvic organ prolapse.
Following these healthy habits can not only help prevent pelvic organ prolapse but also help optimize your overall health.
Watch a Video About Pelvic Organ Prolapse
Medically reviewed by Briana Walton, MD.
