Pelvic Organ Prolapse (POP) is one of the multiple pelvic floor dysfunctions or diagnosis we see in women. Having a better understanding of what it is, who gets it and what to do about it is always a good first line of defense in treating it overall. This article aims at educating you on the general diagnosis and treatment of POP.

Our pelvic floor is a series of muscles, tissue, and fascia that acts like a hammock, or sling to our organs in our pelvis. Our organs include our urethra, cervix, uterus, bladder, and rectum. When our pelvic floor becomes weakened or damaged, these organs no longer have the support they need to begin to descend down and put pressure on our vaginal wall. When this happens, it is considered Pelvic Organ Prolapse, or POP.

Types of Pelvic Organ Prolapse

There are different types of prolapse named for which organs have prolapsed or sagged down. A few of the most common are:

Cystocele (anterior wall prolapse)- when the bladder drops down or out of the vagina.
Rectocele – (posterior wall prolapse) when the rectum drops down or out of the vagina
Uterine prolapse – the uterus drops down or out of the vagina.
Rectal Prolapse – when the rectum drops down towards or out of the anus
Vaginal Vault Prolapse – upper portion of the vagina drops down into the vaginal canal

POP also can be characterized by a grade (grades 1-4). This refers to how far down the organ has prolapsed. You can think of the numbers as mild or grade 1 (just barely lowered down) to severe, grade 4 (organ has prolapsed outside of the vaginal opening).

Symptoms of Pelvic Organ Prolapse

POP is most commonly characterized by a woman feeling a heaviness or as if something was “falling out” of her vagina. Other symptoms/complaints include:

  • Visible bulge in the vagina
  • Pressure /heaviness in your vagina
  • Sensation of a tampon falling out
  • Pressure that is worse with standing, physical activity or intercourse
  • Sensation of feeling like you had something in between your legs when sitting
  • Low back pain
  • Constipation
  • Difficulty emptying bowel/bladder

Urinary Incontinence isn’t a symptom of POP, but often accompanies it. You can read more about UI here. 

Who gets Pelvic Organ Prolapse

Studies are all over the place, but reports up to 90% of women are considered to have POP. 

There is a list of risk factors we have been able to identify that tells us which women are more likely to experience POP. Risk factors include:

  • Increase in age
  • BMI >25
  • Connective tissue disorders (hernias, varicose veins, hemorrhoids)
  • Vaginal delivery
  • Use of forceps during delivery
  • Chronic cough/asthma
  • History of constipation or hard stool
  • History of lifting heavy

How to Treat POP

When treating POP, the main goal is symptom management as opposed to focusing on changing anatomy. We know that a woman’s report of symptoms does not always align with the grade of prolapse. Finding ways for women to feel good, move well and be happy with their bodies should be the goal of treatment, not just “fixing the prolapse”.

Evidence shows us that the most effective treatment for POP is pelvic floor physical therapy as well as the use of a pessary. POP grades 1-3 have been shown to respond very well to conservative treatment without the need for surgical intervention.  

A Women’s Health physical therapist is the first line of defense for women with POP. You can expect:

  • Evaluation of type and grade of POP
  • Pelvic floor strengthening
  • Education on proper pressure management strategies
  • Finding appropriate fitness routines/exercises
  • Discuss POP friendly intercourse positions
  • Train you on proper body mechanics for daily activities to decrease symptoms

Women with POP also could benefit from the use of a pessary, a vaginal insert that supports your vaginal wall; a sports bra for your vagina if you will. A pessary can decrease symptoms during activities that normally aggravate or cause discomfort. A physical therapist can also help you navigate finding and fitting a pessary that works best for you.  

Surgical intervention is appropriate after a full stent of conservative treatment occurs with no reduction of symptoms. Surgical options look to reconstruct your pelvic floor, add in a mesh or device to act as support, or close the vagina altogether to keep your organs up and in a better position.

Other treatments with less evidence include hormone therapy, vaginal rejuvenation, hypopressives, and acupuncture.

If you feel like you might be suffering from POP or want to learn proper strategy and mechanics to decrease chances of POP in the future based on risk factors,  scheduling an appointment with your OBGYN, urogynecologist or pelvic floor physical therapist is a great way to start to begin your return back to symptom-free living.

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