Pelvic Organ Prolapse

Your body’s pelvic region contains organs and structures that are responsible for digestion, reproduction, and urinary function. They are held in place by a group of muscles and connective tissues, and include the:

• Bladder: stores urine until you’re ready to go
• Urethra: the tube through which urine exits the body
• Uterus: where a baby grows during pregnancy
• Vagina: a muscular canal connecting the uterus to the outside of the body
• Small bowel: responsible for absorbing nutrients from food
• Rectum: the final part of the digestive system that helps pass stool

Pelvic organ prolapse (POP) happens when one or more structures drop from their usual position and press against the vaginal wall. In some cases, tissue may even protrude outside the vaginal opening.

This shift can happen gradually, and a pelvic organ prolapse isn’t the same for everyone. The organ involved and the extent of its movement affect both your symptoms and treatment options.

Each type of prolapse is named for the organ that’s affected:

• Cystocele or bladder prolapse: the bladder bulges into the front wall of the vagina.
• Rectocele: the rectum pushes into the back wall of the vagina, often making bowel movements difficult.
• Uterine prolapse: the uterus descends into the vaginal canal and, in more severe cases, it may come through the vaginal opening.
• Vaginal vault prolapse: after a hysterectomy, the top of the vaginal canal may drop into the vaginal space.
• Enterocele: the small intestine presses into the upper or back wall of the vagina, typically after pelvic surgery.
• Urethrocele: the urethra sags into the vaginal wall, usually seen alongside a cystocele.

It is also not uncommon for some women to experience more than one type at the same time.

Your pelvic floor works hard every day, supporting your organs through routine strain like coughing, sneezing, and lifting. Over time, or after events like childbirth, surgery, or menopause, that support can weaken, increasing the risk of prolapse. Common causes include:

• Vaginal childbirth, especially multiple deliveries, prolonged labor, or large babies
• Chronic coughing from conditions like asthma, smoking, or lung disease
• Aging and menopause, which bring a natural decline in muscle tone and collagen
• Extra body weight, which increases pressure inside the abdomen
• Heavy lifting, whether on the job or at the gym
• Genetic predisposition to weaker connective tissues

Symptoms vary depending on which organ is affected and how far it’s shifted. With a minor prolapse, you may not have any symptoms at all. But as the prolapse worsens, you may experience:

• A feeling of pressure or heaviness
• A sensation that something is falling out in the vaginal area
• A visible or palpable bulge at the vaginal opening
• Discomfort or pain during sex
• Trouble fully emptying your bladder or bowel
• Urinary urgency
• Urinary leakage
• Constipation or needing to press on the vagina to help pass stool

Symptoms can often get worse by the end of the day or after standing for long periods.

Your doctor will usually begin with a pelvic exam, which may be done while you’re standing, lying down, or bearing down. This allows them to see how much the prolapse has shifted and if it’s putting pressure on any nearby organs.

Depending on your symptoms, your doctor may include:

• Ultrasound to check internal structures
• MRI to get detailed images of the pelvic organs

If you are having urinary symptoms, urodynamic testing may be done to assess how well your bladder is functioning.

Treatment depends on how much the prolapse is bothering you and how far it has progressed. Many women can manage their symptoms without surgery. Nonsurgical options include:

• Pelvic floor exercises (Kegels). Strengthening the muscles that support your bladder, uterus, and bowel can help reduce mild symptoms when they are done consistently.
• Vaginal pessaries. Small silicone or plastic devices can be fitted and placed in the vagina to hold the prolapsed organ in place. This can be a good option for women who want to avoid or delay surgery.
• Estrogen therapy. Low-dose vaginal estrogen may help improve tissue health, especially for post-menopausal women.
• Managing constipation. A high-fiber diet coupled with good hydration can help prevent straining during bowel movements.
• Lifestyle adjustments. Making changes such as losing excess weight, eliminating strain, and treating chronic cough can all reduce the pressure on your pelvic floor.

If symptoms are severe or you’re not getting relief from conservative treatments, surgery may be recommended. Procedures vary depending on the type of prolapse, but may involve:

• Repairing or repositioning the affected organ
• Reinforcing weakened areas to provide support
• Removing the uterus in some cases of uterine prolapse

You can’t always prevent pelvic organ prolapse, but there are steps you can take to lower your risk:

• Practice daily Kegel exercises to build and maintain pelvic strength
• Keep a healthy body weight
• Treat chronic cough
• Stay regular with your diet, fiber, and hydration to avoid constipation
• Avoid straining when possible

1. Can pelvic organ prolapse get worse if left untreated?

Yes, prolapse can progress over time, especially if the underlying causes aren’t addressed. What may start as occasional symptoms can lead to more pronounced bulging, discomfort, and bladder or bowel issues. Early management is essential, even if your symptoms seem minor at first.

2. Will I need follow-up care after POP treatment?

Whether you’re using a pessary, doing pelvic floor therapy, or have had surgery, regular follow-up will help to ensure your treatment is working. Pessaries need to be checked and cleaned regularly, and surgical repairs should be monitored to make certain results are maintained.

All of our providers are trained in Pelvic Organ Prolapse.