Pelvic organ prolapse (POP)

Pelvic organ prolapse (POP) is the bulging of pelvic organs through the vagina, basically a hernia. Pelvic organs include the uterus, the bladder, the urethra, the rectum, and the vagina itself. This is a very common problem, but most women don’t even know it can happen. Bulging is often minor and without symptoms. As the bulging worsens, it can protrude beyond the vaginal opening and cause significant discomfort. Symptoms can include vaginal pressure, pain with intercourse, inability to fully empty your bladder or rectum, urinary incontinence, and feeling like you are sitting on a water balloon. Symptoms are less in the morning after laying down to sleep during the night. They get worse through the day as gravity pulls your organs down. Strenuous activities such as abdominal exercises, lifting a heavy object, or straining for a bowel movement will often increase symptoms.

POP is caused by damage or weakening of the connective tissue and muscles of the pelvic floor. Genetics is the most important factor related to the strength of these tissues. Pelvic injury can occur with vaginal deliveries or with years of repetitive pressure (chronic cough, asthma, constipation, manual labor). Symptoms can manifest from a woman’s early 20’s to her 90’s.

There are several kinds of prolapse, depending on the organ, or organs, involved. The most common prolapse involves the bladder and is called a cystocele. A prolapse of the rectum is called a rectocele. A prolapse of the urethra is called a urethrocele or hypermobile urethra. A prolapse of the uterus is called uterine prolapse. And a prolapse of the vagina into itself (think of the toe of a sock falling into itself) is called an enterocele. You usually can’t tell which organs are involved. You just recognize your insides aren’t where they used to be. Your doctor can examine you and tell you what is prolapsing and to what degree.

Treatment is based on symptoms. If you can feel a bulge, but it doesn’t bother you, no treatment is needed. If you are having symptoms, you and your doctor should discuss treatment options. These include physical therapy by a pelvic floor specialist, pessary (a plastic brace that is placed in the vagina to hold organs in place) or surgical reconstruction. There are many issues to be considered when deciding what treatment is best for you, including what is prolapsed, your general health status, whether you are sexually active, and the benefits and risks of each treatment. You will be able to make the best decision regarding treatment the more you understand about the options and how they apply to your unique situation. You and your doctor will work together to determine the treatment plan you feel most comfortable with.