Pelvic Organ Prolapse (POP)
If you ever find yourself in a crowd, put your book, phone, or tablet aside for a moment and try putting this statistic into perspective: One in five women suffers from pelvic organ prolapse (Nygaard, 2008). Discreetly look around and imagine every fifth woman you see represents someone who has a pelvic floor prolapse. It's a lot, right?
In reality, that’s millions of women worldwide!
If you’re here, it’s likely pelvic organ prolapse (POP) has affected your life, or the life of someone you care about. Maybe you're not sure what to do next.
But wait; let’s back up a moment for those of us who are new to POP.
WHAT IS PELVIC ORGAN PROLAPSE?
Pelvic organ prolapse is the descent of the bladder, cervix, or rectum into the vaginal canal due to insufficient support.
To understand POP, it's helpful to know more about your pelvic floor muscles.
Everyone (yes, you too men!) has layers of muscle that support their pelvic organs. Pelvic floor muscles start at the pubic bone in the front and stretch to the tailbone in the back, functioning like an internal hammock at the base of the pelvis. Pelvic floor muscles are designed to stretch, support, and rebound under stress.
**IMAGE 1: Needs logo stamp.
In females, this hammock cradles the bladder, the uterus, and the rectum.
Pelvic organ prolapse happens when the forces from above (gravity, intraabdominal pressure, etc.) exceed the forces from below (pelvic floor muscles, fascial support, etc.). If these muscles are damaged or weakened, they may be unable to support the organs--resulting in the collapse of these organs into or through the vaginal canal walls. (Strauhal, 2016)
Are you a visual learner? Check out this quick youtube video that explains POP.
TYPES OF PELVIC ORGAN PROLAPSE
Bladder (Anterior Prolapse/Cystocele) (Bradley, 2014)
A cystocele occurs when the pelvic floor muscles are unable to support the pelvic organs, and part of the bladder "falls" into the front wall of the vagina. A cystocele is the most common form of POP.
Rectum (Posterior Propalse/Rectocele)
A rectocele occurs with 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.
Uterus (Apical/Uterine prolapse)
Uterine prolapse occurs with weakened pelvic floor muscles and ligaments. This is when the uterus slides out of place and "falls" into the vaginal canal.
Although rare, there are situations where the small intestine is affected and collapses into or through the vaginal canal. This is called an enterocele.
NOTE: Notice the “-cele” pattern? Cele is the medical term for pelvic organ prolapse into the vaginal canal!
PRESSURED BY HEAVINESS?
Now that we understand a little more about our pelvic floor muscles and what POP is, let's address the elephant in the room. Many people are unfamiliar and uncomfortable with their anatomy. I know firsthand how difficult it can be to speak up about what feels like the shameful parts of our bodies, but I've also seen the benefits of having these "TMI" talks. The more we have them, the more we realize we are not alone! We also become more comfortable in our own skin, and those around us benefit from the knowledge.
Discussing and understanding our anatomy and how it functions is the first step towards healing. So, take a deep breath with me, and let’s talk!
Perhaps you’ve noticed some heaviness, pain, or bulging in your pelvic region; or, maybe you have other concerns. Let’s address some possible symptoms of pelvic organ prolapse.
Symptoms of POP may depend on which organ has prolapsed, or “fallen” from their place.
The most common indicators of POP are a bulge in the vagina and pelvic heaviness.
If it’s the bladder, you may have urine leakage or difficulty with emptying your bladder. If the rectum is affected, constipation and straining to poop often occur.
According to an article by the Mayo Clinic, posterior propalse (enterocele) and apical (uterine) prolapse are often accompanied with back pain and uncomfortable intercourse.
WHAT TO LOOK FOR WHEN CHECKING FOR A VAGINAL BULGE
Do you have pelvic heaviness or pressure? Have you checked for a vaginal bulge?
Mild bulge (Grade I): generally difficult to see on self-inspection
Moderate bulge (Grade II): a pinkish “ball” that does not go past the entrance of your vagina
Severe bulge (Grade III): a pinkish “ball” that does go past the entrance of your vagina or seems to fall out (Johns Hopkins, 2019)
The bulge will be pinkish. It’s the color of your vagina because what you are seeing IS your vagina.
Why is that? Let’s use the bladder as an example. The bladder AND the vagina share a wall. When the bladder falls, the shared wall is falling into the vaginal canal. The bladder isn’t staying in its lane and it’s taking the vaginal wall down with it. It has dropped into the lane next to it, which is the vagina.
When checking for a bulge, keep in mind self-examination will help you understand more about your body and give insight for when you talk to your healthcare provider. However, it does not determine whether you have pelvic organ prolapse. It’s important that you visit your healthcare provider for a diagnosis. There are multiple calculations and measurements that determine what type and what grade of prolapse you may have. Your women’s health provider may use a test called the POP-Q (Volløyhaug, 2018) during your annual exam to measure the extent your POP.
Other facts to consider when checking for a vaginal bulge:
Symptoms may vary day by day. Some days a bulge may be visible and it may not be visible other days.
Symptoms may vary by time. At 8 a.m. the bulge may not appear and then reappears that same evening.
Positions and activities may affect your symptoms. It’s possible to experience different symptoms when lying down compared to standing, running, or participating in other everyday activities.
TREATING PELVIC ORGAN PROLAPSE
All this information may be shocking and overwhelming, especially all at once, but there IS hope! Pelvic organ prolapse IS treatable. You CAN have a happy, healthy, active life with pelvic organ prolapse! It is not the end of the world.
Although surgery is a common and sometimes necessary choice, we strongly urge you to consider pelvic therapy before undergoing surgery. (Oregon Health & Science University Center for Women's Health, 2019)
If you have a vaginal bulge, constipation, pelvic pain, urinary leakage, incomplete bladder emptying or any of the symptoms mentioned above, meeting with a pelvic therapist may be a great next step.
Pelvic therapists use a variety of interventions, including pelvic floor muscle training, to re-train your muscles to do the right thing at the right time. It’s WAY more than just "doing your kegels!"
In fact, pelvic floor muscle training (PFMT) is the #1 recommended intervention for pelvic organ prolapse! It helps increase muscle thickness, elevates the bladder neck, decreases muscle length, reduces symptoms and much more.
Other interventions may include:
Breathing and force management training
Technology and/or device-assisted pelvic floor muscle training (PFMT) (E.g. biofeedback or electrical stimulation)
Internal support recommendations, like a pessary (Jones, 2010)
Coordination and functional training
Hands-on training/manual therapy
Not sure where to find a pelvic therapist? On myPFM.com we have links to four extensive pelvic health databases to help you find a therapist!
Not able to access a pelvic therapist? Our friends at popuplift.com* have created a great self-paced course to help you live the life you’re afraid you might never return to.
Some more resources on POP:
Check out our amazon store* to see some of our favorite resources and products for pelvic organ prolapse.
Check out our interview with Dr. Annemarie Everett, PT, DPT, WCS, a pelvic floor physical therapist who treats POP.
Check out our interview on prolapse and pessaries with Dr. Sarah M. St. Louis, MD, FACOD, a urogynecologist specializing in female pelvic medicine and reconstructive surgery
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics: Learn where the pelvic floor muscles are, what they do, and how they work
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Are you ready to improve your quality of life, reduce symptoms, and get back to living life? It’s our goal to get you there.
We understand, this is a lot of information to take in, and you may still have questions. We’d love to answer them. Post your questions in the comments section below.
Was this article helpful? How has POP affected your life? Let’s continue the conversation in the comments section below.
By Zemrie DaCosta with Jeanice Mitchell, PT and Emily Reul PT, DPT
Posterior vaginal prolapse (rectocele). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rectocele/symptoms-causes/syc-20353414. Published March 8, 2018. Accessed February 9, 2020.
Nygaard, I., et al. (2008). Prevalence of Symptomatic Pelvic Floor Disorders in U.S. Women. JAMA; 300(11): 1311–1316.
Pelvic floor disorders. UChicago Medicine. https://www.uchicagomedicine.org/conditions-services/pelvic-health/pelvic-floor-disorders. Accessed February 9, 2020.
Pelvic prolapse. Oregon Health & Science University Center for Women's Health. https://www.ohsu.edu/womens-health/pelvic-prolapse. Accessed November 3, 2019.
Meikle S, Kunkle C. Pelvic organ prolapse. Office on Women's Health. https://www.womenshealth.gov/a-z-topics/pelvic-organ-prolapse#11. Published 2016. Updated May 14, 2019. Accessed November 3, 2019.
Strauhal MJ, Swenson C, Rosenman A. Pelvic organ prolapse. Our Bodies Our Selves. https://www.ourbodiesourselves.org/book-excerpts/health-article/pelvic-organ-prolapse/. Published August 3, 2016. Accessed November 3, 2019.
Bradley CS. Cystocele (prolapsed bladder). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/cystocele-prolapsed-bladder. Published March 2014. Accessed November 3, 2019.
Cystocele. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/cystocele. Accessed November 3, 2019.
Jones, K.A., et al. (2010). Pessary Use in Pelvic Organ Prolapse and Urinary Incontinence. Reviews in Obstetrics & Gynecology; 3(1).
Volløyhaug I, Rojas RG, Mørkved S, Salvesen KÅ. Comparison of transperineal ultrasound with POP-Q for assessing symptoms of prolapse. Int Urogynecol J. 2019 Apr;30(4):595-602. doi: 10.1007/s00192-018-3722-3. Epub 2018 Aug.