Pelvic Organ Prolapse: what it is, what are the symptoms, and what you can do
At Empower Pelvic Health we love education and learning and believe that knowledge is power and the key to advocating for yourself with medical providers. We want to begin sharing knowledge this way because it can be so easy to read snippets or watch short clips and get incomplete or incorrect information. We want to provide you with big picture information and empower you through learning so that you can not only advocate for yourself but also support other women who deal with similar things. We are not alone in what is going on, even when it may feel like no one else is experiencing the same things. Today, we are going to define pelvic organ prolapse, explain the different types and grades/stages, talk about symptoms and related causes, and what you can do about it.
Firstly, you should know that approximately one in five women suffer from pelvic organ prolapse (Nygaard, 2008). You did not misread that… appx 20% of women live with pelvic organ prolapse. What a staggering number! Imagine you are at a children’s birthday party full of other women and mommas. Think about all of the women there. 20% of those women represent someone who has a pelvic floor prolapse. It’s a lot, right? Now think about all the women in the world. Almost four billion according to the UN, with around 25% of that number being fifteen or younger. So approximately three billion women in the world, and around 20% of that number has a pelvic organ prolapse. That’s millions and millions of women!
Now, what exactly is pelvic organ prolapse (POP)? It is the descent of the bladder, cervix, or rectum into the vaginal canal due to a lack of support from the pelvic floor muscles and other pelvic structures. Everyone, both male and female, have layers of muscles that support their pelvic organs, also called the pelvic floor. These muscles start at the pubic bone in the front and run all the way to the tailbone in the back. You can think of them like an internal hammock at the base of the pelvis. They are designed to stretch, support, and rebound under stress. In females, this hammock-like structure cradles the bladder, the uterus, and the rectum. An important thing to know is that no one prolapse is the same, not even in the world of pelvic floor physical therapy. There are five types of POP, but the most common are: Cystocele or bladder prolapse, Rectocele or rectal prolapse, and Uterine prolapse, though someone can suffer from more than one type.
A cystocele occurs when the pelvic floor muscles cannot support the pelvic organs and part of the bladder “falls” into the front wall of the vagina. This is the most common form of POP.
A rectocele occurs when the pelvic floor tissue between the rectum and the vagina weakens or thins, and part of the rectum may “fall” into the back wall of the vagina.
Uterine prolapse occurs when weakened pelvic floor muscles and ligaments allow the uterus to slide out of place and “fall” into the vaginal canal.
A person can suffer from a combination of prolapse in any combination of the five types, though most commonly have a combination of cystocele, rectocele and uterine prolapse.
Now, clarity is important. When we say the word “falls” we are not implying that your bladder, rectum or uterus is actually inside of your vagina. Rather, we are applying the most appropriate term for the weakening of the tissue that allows the various pelvic organs to “bulge” into the vagina. Think of it like a balloon. If you inflate a balloon and apply pressure on one side, your hand will bulge into the balloon but not be in the balloon.
Within the varying types of pelvic organ prolapse there are also grades or stages; they range from one through four. (See picture below provided by pelvic guru.) A urogynecologist may grade or stage your POP as follows:
Stage 1: mild bulge.
Stage 2: moderate bulge that does not go past the entrance of your vagina.
Stage 3: Severe bulge that goes past the entrance of your vagina or seems to fall out.
Stage 4: Significant bulge without the ability to be reduced into the vaginal canal.
Other than Stage 4, POPs can and should be treated conservatively by a pelvic floor physical therapist before surgery is ever considered.
You may be asking what symptoms are associate with pelvic organ prolapse. The most common symptom of POP is a feeling of heaviness or pressure in the vagina. Some women describe this sensation as “sitting on an egg.” It typically worsens as the days goes on, as you spend more time on your feet, or when you have been vomiting/coughing a lot due to an illness. Another sensation that can be described is a looseness or the feeling like “something is going to fall out”; it isn’t, but the sensation can be very real and unusual. Gravity, poor pressure management, and poor posture as the day continues can play a part in the worsening of your symptoms throughout the day. Other common symptoms of pelvic organ prolapse are:
· Leaking urine
· Inability to completely void bladder
· Back pressure or pain
· Pain with intercourse
· Feeling of laxity (looseness) within the vagina
· Difficulty reaching orgasm
· Worsening or lead to constipation
· Needing to insert fingers into the vagina to assist with bowel movements (pushing against the walls of the vagina to move stool through the anus)
Often times, your symptoms’ severity does not necessarily match the grade or stage of your POP. What does this mean? Frankly, a mild prolapse can have multiple, potentially severe symptoms while a severe prolapse may only have urinary symptoms, or even none at all.
The first thing you should do if you think that you may have a pelvic organ prolapse is take a nice, big breath. Prolapse is not a death sentence. Like we have already mentioned, it is more common than you think and, no matter how alone you may feel in your situation, you are not the only woman experiencing these things and likely not the only woman you know who has. After taking that nice, big breath, you should seek care from either a board-certified urogynecologist or a pelvic floor physical therapy specialist.
A pelvic floor physical therapist will look locally at your pelvic floor through an internal, individualized assessment and determine the strength, power, coordination, and timing of your pelvic floor muscles. Remember how every prolapse is different? An individual assessment will give the best idea of what is going on with your prolapse. Furthermore, and truly most importantly, your pelvic floor physical therapist should assess your global musculoskeletal system to determine how your whole body is functioning with itself, pelvic floor included. Almost always there are contributing factors outside of the pelvic floor that need to be taken into account in order to treat not only your pelvic organ prolapse and other pelvic floor dysfunctions, but also the cause and the cause of the cause.
Some, but not all, of the external factors assessed during the global musculoskeletal evaluation are:
· Spinal mobility
· Core strength
· Pressure management
Now, when we talk about pressure management, what exactly do we mean? We are talking about the way your system handles increased pressure in the abdomen. Remember the structure of the pelvic floor and how it is shaped like a hammock and is designed to stretch, support, and rebound under stress? This stress can be gravity, but it can also be intra-abdominal pressure. Your pelvic floor works with several other structures, altogether called the container, to help your body manage pressure in just the right way. An imbalance, a lack of synchronicity, and a lack of coordination between these structures can create issues like pelvic organ prolapse, which more specifically, occurs when a system is handling too much pressure. Your pelvic floor physical therapist is going to take this into account when completing the external assessment, combine these findings with those from the individualized, internal assessment and develop a personalized treatment plan for you in order to address your symptoms, their cause and the cause of the cause.
Have you recognized yourself in this post? Do you find yourself suffering from similar symptoms described above? Remember, you are not alone and there is something to do! Use the button below to contact our Patient Care Coordinator directly. She would love to speak with you personally about what you’re experiencing and discuss care and scheduling your first visit.
1. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008 Sep 17;300(11):1311–6.[PMC free article] [PubMed] [Google Scholar]
2. The World Bank (n.d.). Population, female. Retrieved April 19, 2023, from https://data.worldbank.org/indicator/SP.POP.TOTL.FE.IN