What is Pelvic Organ Prolapse (POP)?

Today, we're going to discuss pelvic organ prolapse (POP). Below is a high-level overview.

Reminder: This information is meant to be educational in nature; it is not medical advice. Always talk to your doctor about any symptoms you are experiencing.

[Editor's note: This article was reviewed and updated with additional links on 1/4/22.]

What is pelvic organ prolapse?

When the tissues and muscles supporting the pelvic organs (bladder, rectum, small bowel, uterus, vagina, cervix) weaken or loosen, the pelvic organs can descend or "prolapse." According to the International Urogynecological Association (IUGA), vaginal prolapse affects "up to half of adult women."

When discussing pelvic organ prolapse, you'll likely encounter the following terms/phrases:

• Cystocele (or anterior vaginal wall prolapse): The bladder has prolapsed into the vagina. This is the most common type.
• Enterocoele: The small intestine creates a bulge into the vagina.
• Rectocele (or posterior vaginal wall prolapse): The rectum creates a bulge into the vagina.
• Urethrocele: A prolapse of the urethra (the tube that carries urine).
• Uterine prolapse (or apical): The cervix or uterus is now entering or falling out of the vagina.
• Vaginal vault prolapse: Prolapse of the vagina following a hysterectomy or removal of the uterus.
  
  

What causes pelvic organ prolapse?

Pelvic organ prolapse occurs when the pelvic floor muscles weaken or loosen. A number of factors can contribute to the muscles weakening, but some of the more common factors include:

• Aging
• Pregnancy
• Obesity
• Chronic constipation/straining
• Chronic cough
• Hormonal changes due to menopause
• Heavy lifting
• Family history

Again, this isn't an exhaustive list. Regarding aging, WomensHealth.gov notes, "About 37% of women with pelvic floor disorders are 60 to 79 years of age, and about half are 80 or older."

What are pelvic organ prolapse symptoms?

Prolapse is often without symptoms. Some women experience:

• Pelvic pressure
• Voiding dysfunction
• Lower backache
• Feeling of fullness
• Seeing or feeling a vaginal bulge
• Pelvic pressure that can get worse with standing or as the day goes on

It's important to note that a number of patients might be asymptomatic, meaning they don't experience any symptoms at all.

How is pelvic organ prolapse diagnosed?

Pelvic organ prolapse is diagnosed by pelvic exam. From there, your doctor might conduct other tests depending on symptoms and severity of prolapse.

Other possible tests include:

• Cystoscopy: an office procedure where a physician places a scope and looks inside your bladder
• Urodynamic testing: tests bladder function
  
  

How is pelvic organ prolapse treated?

Pelvic organ prolapse can interfere with a person's quality of life. Fortunately, it does not impact one’s quantity of life.

As noted above, some patients don't experience any symptoms and don't need treatment. For patients experiencing symptoms, especially ones interfering with day-to-day activities, they might opt for treatment.

Treatment for pelvic organ prolapse includes:

• Pelvic floor physical therapy. You learn exercises that will strengthen the pelvic floor muscle. For mild cases, this might be the only treatment a patient will need.
• Medical supportive devices. Specifically a pessary, which is a plastic device inserted into the vagina. The pessary provides support to the pelvic organs.
• Surgery. Surgery can range from minimally invasive (such as colpocleisis, a type of obliterative vaginal surgery that narrows the opening of the vagina using sutures) to reconstructive surgery.
  
  

What should you do if you have pelvic organ prolapse—or you suspect that you do?

Bottom line: Talk to your doctor! Get an accurate diagnosis. From there, you and your physician can discuss treatment options. And, of course, consider making an appointment with Greater Boston Urology!