All About Pelvic Organ Prolapse
Pelvic organ prolapse (POP) is a common condition affecting many people. Unfortunately, it is not often talked about, leaving those who experience this condition to feel alone and confused. We are here to go over what exactly POP is, why it happens, and what you can do to stop it if it does happen to you.
What is pelvic organ prolapse?
POP occurs when one or more organs descend from their normal resting position in the pelvic cavity. Most commonly, these organs are the uterus, bladder, or rectum. This can present as a feeling of "heaviness", or bulging around the vaginal opening or rectum. Depending on the severity, you may also see or feel something externally.
What causes pelvic organ prolapes?
This condition is caused by weakness and laxity in the connective tissue, ligaments, and muscles of the pelvic floor. Normally these structures are strong and “bouncy” like a trampoline, ascending and descending with your breath and supporting your organs appropriately with changes in pressure (exercise, lifting, etc.).
Changes during pregnancy and during birth can cause this laxity and we can see the organs begin to drop. But it is not uncommon for women who have not given birth to also experience prolapse. Some contributing factors aside from pregnancy and childbirth are hormonal changes with menopause, aging, surgeries like hysterectomies, straining during bowel movements, heavy lifting/exercise with breath holding, chronic coughing, and genetics.
When an organ drops, this organ or another one that it’s placing pressure on, can descend and bulge out of the vagina.
Types of Pelvic Organ Prolapse
Cystocele
This occurs when the bladder protrudes into the vagina. If you are experiencing this, you may feel pelvic pressure, leakage when coughing, sneezing, or lifting heavy options.
Rectocele
Rectocele happens when the rectum protrudes through the back wall of the vagina causing constipation, pressure, and feelings of discomfort during intercourse.
Enterocele
This occurs when the small intestine protrudes into the vagina. Those experiencing this may feel pressure, lower backache, and discomfort during intercourse.
Vagina Vault Prolapse
A vagina vault prolapse is caused by tears or detachment of the top of the vagina from the attachment to the bony pelvis, causing the front and back vaginal wall to fall.
Uterine Prolapse
Uterine prolapse happens when the pelvic muscles become weak, causing the the vaginal opening to widen. This allows the uterus to drop, leading the cervix to fall into the vaginal canal. This can cause pelvic pressure, lower backaches, and discomfort during intercourse.
What are prolapse symptoms?
People with pelvic organ prolapse may experience one of many of the following:
Leaking urine or stool
Discomfort or heaviness in the vagina
Pain with sex
Noises from your vagina during exercise
Seeing tissue coming out of your vagina
Back pain
Difficulty reaching orgasm
Constipation
What do I do if I have a prolapse?
Since there are many different types of POP and lots of variability in each individual’s contributing factors, it’s important to see a specialized pelvic floor physical therapist who has experience assessing and treating this condition. It may be tempting to do a quick google search and start trying kegels, but this can often do more harm than good. Many people suffering from POP actually have TOO much tension in their pelvic floors. The muscles and fascia, therefore, require releasing and relaxing BEFORE strengthening. A specialist will be able to tell you exactly what you need to do to get on the road to restoring your pelvic floor and create an individualized treatment plan for your specific needs. Another important thing is NOT to wait to seek pelvic organ prolapse treatment. Many times people push it off because they are nervous or think it's "normal." We like to stress that common does not mean normal and if you feel like something is not right, it's best to seek help from a pelvic floor physical therapist right away and hopefully negate the need for less conservative treatments.
Pelvic Organ Prolapse Q&A
Is pelvic organ prolapse normal after having a baby?
Pelvic organ prolapse can be common after pregnancy and childbirth, but that does not mean you have to live with symptoms. Pregnancy and birth can place significant stress on the muscles, fascia, and connective tissues that support the pelvic organs. Some people notice symptoms immediately after birth, while others may not notice changes until months or even years later.
If you are experiencing heaviness, pressure, leaking, or a feeling of bulging, a pelvic floor physical therapist can help determine what is contributing to your symptoms and what your body needs to recover.
Can you have pelvic organ prolapse without having children?
Yes! Although pregnancy and childbirth are common contributors, they are not the only causes of pelvic organ prolapse. People who have never been pregnant or given birth can also experience prolapse.
Factors such as genetics, hormonal changes, aging, chronic constipation, chronic coughing, previous pelvic surgeries, and repeated increases in abdominal pressure can all play a role.
Can pelvic organ prolapse get better on its own?
Symptoms can sometimes improve, particularly when contributing factors such as constipation, excessive straining, or poor pressure management are addressed. However, it is important not to simply ignore symptoms and hope they disappear.
A pelvic floor physical therapy evaluation can help identify what may be contributing to your prolapse and give you specific strategies to improve support, pressure management, mobility, and pelvic floor function.
Do I need to do Kegels if I have a prolapse?
Not necessarily. This is one of the biggest misconceptions about pelvic organ prolapse.
While strengthening the pelvic floor can be helpful for some people with prolapse, not everyone needs more strengthening. Some people have pelvic floor muscles that are already working overtime or holding too much tension. In these cases, repeatedly doing Kegels may not address the underlying problem and can potentially make certain symptoms worse.
The goal is not simply to have a "strong" pelvic floor. Your pelvic floor needs to be able to contract, relax, lengthen, and respond appropriately to changes in pressure.
Can I exercise if I have pelvic organ prolapse?
In many cases, yes! A prolapse diagnosis does not automatically mean you have to stop exercising.
The key is learning how to exercise in a way that works with your body's current capacity. Your pelvic floor physical therapist can help you modify exercises, improve breathing and pressure management, and gradually build strength and tolerance.
Rather than being afraid of movement, the goal is to help you feel confident moving your body again.
Can pelvic organ prolapse cause back pain?
It can. Pelvic organ prolapse does not always present with obvious vaginal symptoms. Changes in pelvic support, muscle tension, breathing patterns, and the way your body manages pressure can contribute to discomfort in the pelvis, hips, or lower back.
Back pain can have many different causes, though, so it is important to have an individualized assessment rather than assuming your pain is solely related to prolapse.
Can pelvic organ prolapse affect sex?
Yes. Some people with prolapse experience discomfort, pressure, pain, or a feeling of something being "in the way" during sex. Others may notice changes in sensation or difficulty reaching orgasm.
These symptoms can be related to changes in pelvic floor muscle tension, tissue mobility, hormonal changes, or the position of the pelvic organs. Pelvic floor physical therapy can address many of these contributing factors and help you feel more comfortable and confident during intimacy.
Can pelvic organ prolapse be treated without surgery?
Yes. Many people with pelvic organ prolapse can benefit from conservative treatment. Depending on your individual situation, treatment may include pelvic floor physical therapy, breathing and pressure-management strategies, strengthening, relaxation techniques, lifestyle modifications, and other individualized approaches.
More significant prolapse may sometimes require additional medical management, such as a pessary or surgery. Your healthcare team can help you determine which options are appropriate for you.
Should I see a pelvic floor physical therapist if my prolapse isn't painful?
Yes. Pain is not required for prolapse to be worth addressing. You may notice pressure, heaviness, urinary or bowel changes, a bulging sensation, or a feeling that something simply isn't quite right.
Even if your symptoms are mild, getting evaluated can help you understand what is happening and learn strategies to prevent symptoms from becoming more limiting.
Does having a prolapse mean it will keep getting worse?
Not necessarily. A prolapse diagnosis does not mean that your symptoms will automatically continue to progress.
Your symptoms can be influenced by many factors, including hormonal changes, constipation, activity level, pressure management, muscle function, and overall tissue health. Addressing these factors and learning how to work with your body can help you manage your symptoms and maintain your quality of life.
When should I see a doctor or pelvic floor physical therapist for prolapse?
If you notice a new bulge, pelvic pressure or heaviness, urinary or bowel changes, discomfort with sex, or tissue protruding from the vagina, it is worth getting evaluated.
You do not have to wait until your symptoms become severe. Early evaluation can help you understand what is happening and determine what treatment options may be appropriate for you.
Most importantly, you don't have to figure this out alone. Pelvic organ prolapse is common, but struggling with symptoms in silence doesn't have to be.
Contact us today to talk about what we can do to help you with pelvic organ prolapse at (401) 602 -7006, or any other concerns you have about your pelvic health!