Pelvic organ prolapse, or POP, is a condition in which the muscles, tissue, and ligaments that support the organs of the pelvis (the pelvic floor) are too weak to support and hold your organs in place properly. 

Essentially, the muscles of the pelvic floor work like a strong sling supporting the organs such as the rectum, uterus, bladder, and vagina. And if these organs lose their strength or sustain considerable damage, they may shift out of place. 

For the most part, in mild cases of the condition, the organs may only drop, but in more severe instances, they may even protrude outside the vagina, causing bulges. 

Along with fecal and urinary incontinence, pelvic organ prolapse is a pelvic floor disorder, and these conditions may occur together in some cases. 

In this article, our experts will discuss POP, the leading causes, and pelvic organ prolapse treatment options. 

Types of Pelvic Organ Prolapse

Patient in the Doctor’s Office, She Is Receiving Prescription Medicine.

The type of condition will usually depend on the weakness in the pelvic floor and the affected pelvic organs. As such, there could be: 

  • Dropped bladder or anterior vaginal prolapse: The muscles above the vagina become weak, causing the bladder to dislocate and create a bulge in the vagina. Experts often call these prolapses cystoceles, which is the most common POP type. 
  • Enterocele: The muscles are weak around the small intestine, which may create a bulge at the top or the back wall of the vagina. 
  • Vaginal vault prolapse: The muscles of the pelvic floor become weak, and the vaginal vault, or the upper part of the vagina, shifts place down to the vaginal canal. 
  • Urethrocele: This condition causes the urethra (a tube carrying pee outside of the body from the bladder) to drop. Often, the bladder drops as well. 
  • Dropped rectum: As the name suggests, the weakened muscles may also cause the rectum to create a bulge on the vagina’s back wall (rectocele or posterior vaginal prolapse). 
  • Uterine prolapse or dropped uterus: The weak muscles of the pelvic floor cause the uterus to shift into the vaginal canal. 

Both women and men can experience the condition, but females are at a higher risk. Also, men will only experience a dropped rectum and/or bladder.

Also, around three to 11% percent of women experience pelvic floor disorders (along with POP), and most are between the ages of 60 and 79, with around 50% of patients being 80 or older. 

In some cases, the condition causes no symptoms making it difficult to know just how prevalent pelvic floor disorder is. 

Causes and Symptoms of POP

The most obvious sign of the condition is a feeling of a bulge in the vaginal area as if something was falling out. Other symptoms are usually the following: 

  • An aching pelvis that feels full and pressured
  • Painful intercourse (more of a hitting sensation and pressure)
  • The need to shift protruding pelvic organs with fingers to be able to poop and pee
  • Aches and pain in the lower back
  • Pressure, a bulge, or fullness in the vagina
  • The pressure worsens during the day or gets more intense when the patient stands for too long or coughs
  • Vaginal spotting

Usually, the symptoms are dependent on the location of the prolapse. And as mentioned before, urge incontinence, stress, and fecal incontinence often appear together with pelvic organ prolapse and may cause the following accompanying symptoms: 

  • A frequent urge to urinate that’s difficult to control (urge incontinence)
  • Urine leaks when the patient exercises, coughs, or laughs (stress incontinence)
  • Being unable to control bowel movements or constipation (fecal incontinence)

When discussing causes, experts agree that several things may increase the likelihood of POP, such as the following:

  • The aging process usually causes the body’s muscles to lose strength, making the pelvic floor muscles weaker as well. Declining estrogen during menopause may also cause the connective tissues supporting the pelvic floor to become weaker. 
  • A family history of the condition may also increase the odds of someone developing it. As of now, the research has no clear answers to this, but people can likely inherit weaker pelvic floors. 
  • Being heavier can also increase the risk of developing POP. Studies have confirmed that clinically overweight or obese people have a higher chance of experiencing pelvic organ prolapse. 
  • Collagen irregularities can weaken the pelvic floor’s connective tissue. Some disorders like Ehlers-Danlos Syndrome may increase the risks of developing the condition. 
  • Vaginal childbirth is arguably the most common cause of POP. Carrying and delivering a larger-than-average baby or twins and triplets may injure the pelvic floor muscles, leading to the condition.  
  • Long-term abdominal cavity pressure can overwork the pelvic muscles, weakening them. Chronic coughing, constipation, and heavy lifting may all increase the chances of experiencing problems with POP. 

Diagnosing Pelvic Organ Prolapse

Before establishing a diagnosis, experts will most likely perform a pelvic exam and cervical screening while reviewing the patient’s symptoms. Often, healthcare providers will order additional tests such as: 

  • Different imaging procedures like ultrasound or MRI to get detailed images of the prolapse and to determine its extent. 
  • Bladder function tests to look for urinary issues. The testing may include a cystoscopy or urodynamics. 

While establishing a diagnosis, doctors will also classify the condition, based on the severity of the prolapse, with stage zero indicating no organ shift and, in contrast, stage four indicating complete prolapse, i.e., the organs are bulging out of the body. 

Pelvic Organ Prolapse Treatment

For the most part, healthcare providers will discuss nonsurgical treatment options at first to avoid the risks and complications often associated with surgery. If these don’t work, then surgical procedures will be recommended. 

Nonsurgical pelvic organ prolapse treatments

  • Pelvic floor exercises or Kegel exercises strengthen the pelvic floor. To master these pelvic floor exercises, your doctor may refer you to another expert, such as a physical therapist. 
  • A vaginal pessary is a removable silicone device that’s inserted into the vagina holding the dropped organ in place. 

Surgical Pelvic Organ Prolapse Treatments

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As mentioned above, surgery will mostly become an option if there’s no improvement from nonsurgical treatments and if the patient no longer wants to have children, as giving birth after surgery may cause the prolapse to return.  

Usually, experts either use reconstructive or obliterative surgery. In the latter, experts sew the wall of the vagina shut, preventing the organs from sagging. Reconstructive surgery aims to repair the weak areas of the pelvic floor. 

To be more specific, there are several surgical options, including the following: 

  • Colposleisis
  • Colporrhaphy
  • Sacrohysteropexy
  • Sacrocolpopexy
  • Sacrospinous or uterosacral ligament fixation

In some cases, additional surgical procedures may also be necessary. To learn more about them, feel free to reach out to our trained experts in the medical fields of obstetrics and gynecology in South Miami, Florida.

There’s Always Help

While most causes of the condition are out of your control, you can reduce the risks of POP by incorporating healthy habits. Performing daily pelvic floor exercises, eating healthy, maintaining a healthy weight, learning proper lifting techniques, and quitting smoking can all decrease the risk of experiencing problems with your pelvic floor muscles.  

Also, visiting an expert with whom you can discuss your concerns is essential in avoiding or getting proper treatment for these conditions. That said, feel free to reach out to us and schedule an appointment today.