Pelvic Organ Prolapse

POP is usually caused by added pressure or trauma in the pelvic area.

The muscles and ligaments that provide support to the cervix, vagina, bladder, rectum, small bowel, urethra, and uterus (pelvic area) sometimes become weak. When this happens, the structures in this area may move down lower and create a prolapse, or bulge, in the vagina. The condition is referred to as pelvic organ prolapse (POP).

  • It’s most likely to occur following some type of trauma in the pelvic area or as a result of childbirth.
  • If persistent pressure or discomfort is experienced, there are several treatment options that may resolve the problem.

What Causes Pelvic Organ Prolapse?

Pelvic tissues may weaken over time
Hormonal and structural changes can contribute
Previous surgeries may affect pelvic support
illustration with pelvis highlighted red

Changes associated with menopause sometimes weaken soft tissues. Some women experience POP following surgery for other conditions affecting reproductive or urinary organs. For instance, POP sometimes develops after a woman has a hysterectomy to remove the uterus. Pelvic organ cancers, obesity, and respiratory ailments that lead to chronic coughing are other factors that sometimes contribute to POP.

How Can You Tell If You Have POP?

It’s possible to have pelvic organ prolapse without any noticeable symptoms. Symptoms may vary and some patients may not notice them immediately.

It’s possible to have pelvic organ prolapse without any noticeable symptoms. When symptoms are experienced, there may be a feeling of pressure in the pelvic area. Some women might notice discomfort during sex, while others may experience urinary incontinence (UI) or see a bulge that extends to the opening of the vagina. Additional symptoms associated with POP include:

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Lower back pain
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Sensations of something in the vagina or feeling like something is falling out
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Vaginal bleeding or spotting

How Is It Diagnosed?

A PAP smear may be performed
X-rays of the urinary tract may be used
Imaging tests may include CT scans, MRI, or ultrasound
Results from physical examinations help confirm diagnosis

A pelvic exam is usually done to determine if pelvic organ prolapse has occurred. Medical history and findings from a physical examination are also considered during diagnosis.

Non-Surgical Treatment Options for POP

Kegel exercises strengthen pelvic muscles
Behavioral treatments may improve symptoms
Vaginal pessaries support pelvic organs
Devices help hold organs in position

Treatment will depend on the extent of prolapse and the symptoms experienced. Some patients benefit from Kegel exercises and similar behavior treatments. In some situations, support for the bulging or dropped organs may be provided with a pessary, a device that’s inserted into the vagina.

When Is Surgery Recommended for Pelvic Organ Prolapse?
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Surgical Repair Options
If pain is significant or symptoms are affecting quality of life, surgery for POP may be recommended. Surgical options include repairing weakened tissue, closing the vaginal canal (colpocleisis), restoring the correct position of the vagina, or removing the uterus or other protruding organs.
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Minimally Invasive Approaches
Many procedures performed today use minimally invasive techniques. Surgery is usually selected based on which organs are primarily affected and whether other related conditions are present.
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Prevention and Risk Reduction
If pelvic organ prolapse is suspected, a doctor may refer a patient to a urologist for further evaluation. The risk of developing POP may be reduced by maintaining a healthy weight, avoiding smoking and chronic coughing, managing constipation, strengthening pelvic muscles, and using proper lifting techniques.