Pelvic organ prolapse affects millions of women; however, it is estimated that less than 50% of them have discussed it with a medical provider. Pelvic organ prolapse, also called POP, can have a significant impact on everyday life. Many women do not even know their symptoms are related to POP and attribute them to normal changes after childbirth or menopause.
POP can cause a variety of symptoms and range from barely noticeable to severe. Organ prolapse is something not widely discussed, but with the right information and treatment, it can be better managed. As a nurse, this is what I wish more women knew about pelvic organ prolapse.
What is Pelvic Organ Prolapse?
POP is when any of the pelvic organs- the vagina, uterus, bladder, or rectum sag below their normal position. With POP, organs can also push into (bulge) another organ or fall outside the body. The sagging of these organs can occur when the muscles, ligaments, and other tissues in your pelvic floor weaken and can no longer support your organs. You can think of the pelvic floor like the bottom of a paper grocery bag. When loaded with the right amount of groceries, the bag supports the weight; if the bag becomes weak, damaged, or is overloaded, the groceries begin to shift and bulge towards the bottom or sides of the bag.
Types of Pelvic Organ Prolapse
There are different types of prolapse, categorized by which organ is affected and where it is located. It is possible to have prolapse of more than one organ at a time. These are the different types of POP:
Uterine Prolapse: This occurs when the uterus moves down and is bulging or pressing into the vagina. In more severe cases, the uterus can drop down fully and come out of the vagina.
Anterior Vaginal Wall Prolapse: This type of POP is also called a cystocele, or bladder prolapse, and occurs when the bladder descends and presses against the anterior (front) wall of the vagina. The bulge from the bladder can drop down far enough that it comes outside of the vagina.
Posterior Vaginal Wall Prolapse: Also called a rectocele, this type of POP occurs when the rectum pushes into the back or posterior wall of the vagina; it can also bulge outside of the vagina.
Uterovaginal Prolapse: This is the term used when more than one organ drops or bulges.
Symptoms Associated with Pelvic Organ Prolapse
Symptoms can vary depending on what type of POP. However, most women will describe a sense of fullness or pressure in their vagina. A common sensation I hear women describe is that it feels like a tampon is stuck, but there isn’t one present. Additional symptoms associated with POP can include:
- Pressure or discomfort in the pelvic area, which can include tailbone pain
- Pain during intercourse
- Changes with bladder control such as incontinence
- Changes with bowel habits including constipation
- Needing to splint or place pressure in the perineal area (the space between the vagina and the anus) to have a bowel movement
How Pelvic Organ Prolapse is Diagnosed
Bringing up POP symptoms and concerns to a medical provider is a big barrier to getting a diagnosis and treatment. Often, POP symptoms can feel embarrassing or intimate, and women try to manage symptoms on their own. A diagnosis of POP is made through a pelvic exam. You will lie on an exam table, and a speculum will be placed in the vagina to allow the provider to see inside the vagina and cervix. With more pronounced POP, the bulge or prolapse may be seen outside or right inside the vagina. To see any less obvious bulging, the provider will have you bear down like when having a bowel movement. This helps them see what the walls of the vagina do when under pressure and helps them diagnose the type of POP you may have.
Your provider may also perform an internal exam with their fingers and also examine the perineal area, including the anus and rectum, as these areas can be impacted by POP as well. In some cases, if the bulge cannot be found when lying down, your provider may have you stand and bear down again, which can help identify POP as well.
POP is diagnosed based on the location and severity of the prolapse. A scale from 0 to 4 is commonly used to stage POP, with 0 being normal or no prolapse and 4 being a prolapse that extends outside of the vagina. Staging can help guide treatment and track any improvement or worsening of the prolapse over time.
Treatment Options For Pelvic Organ Prolapse
Treatment largely depends on how the symptoms are affecting you. Some women may have no symptoms, or the symptoms are so minimal that they’re not disruptive to daily life. Current evidence-based treatment guidelines for women with minimal to no symptoms are just to monitor and observe annually. For many women, their symptoms may never worsen or progress, and for some they can even improve if the POP is minimal.
For those who have moderate to severe symptoms or symptoms that are disruptive to daily life, there are different treatment options available:
- Vaginal Pessary: A pessary is a silicone device that comes in different shapes and sizes and is inserted into the vagina to support the tissue and help pelvic organs stay in the right place. Pessaries can be self-managed, which allows them to be inserted and removed at home. Other types of pessaries are inserted by a medical professional and left in place for up to 3 months before being replaced.
- Pelvic Floor Physical Therapy: This treatment option is recommended for most women and can be combined with all other treatment options. Specialized pelvic floor therapists can help you to strengthen your pelvic floor muscles through targeted exercises, stretching, and biofeedback. Strengthening the pelvic floor muscles can help provide more support to your pelvic floor and reduce POP symptoms.
- Incontinence Products: Many women who have POP experience issues with bladder control; this can include urinary frequency and urgency, both of which can cause incontinence or leaking urine. While treatment for POP can help reduce some of these symptoms, using incontinence products is a good way to manage leaks short and long term. There are products made just for women, including discreet, high-absorbency pads and disposable underwear, depending on the amount of urine leakage.
- Surgery: When POP symptoms disrupt daily life, or the prolapse is more severe, surgery may be an option. Surgery depends on the type and location of prolapse, and there are several approaches. The goal of surgery is to help reposition the pelvic organs back into the right place or remove the tissue creating the bulge. Surgery is not always successful, and there is risk of the prolapse coming back, so it is important to discuss all options and risks with your treating provider.
Your Symptoms Deserve to Be Heard
It can be easy to minimize symptoms or avoid discussing them with a provider altogether. Many women hope the symptoms may improve or go away on their own and don’t seek help. Pelvic organ prolapse can be common among women, yet many never seek help. Your symptoms deserve to be heard so that an individualized treatment and management plan can be developed. There are many options available to help manage and reduce symptoms, improving quality of life.
