What Is Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) happens when a pelvic organ drops from its normal position due to surrounding muscle weakness or damage. POP typically occurs after pregnancy, childbirth, and sometimes menopause. The affected organs can include the uterus, cervix, vagina, prostate, bladder, urethra, or rectum.

Many POP cases do not come with noticeable symptoms, but some people experience pressure or bulging in the vaginal area and other similar signs. After a diagnosis, treatment options might involve close observation, support from a vaginal device, or surgery.

This article discusses the different types of pelvic organ prolapse, outlining the general symptoms, diagnostic process, and treatment options for this condition.

Types of Pelvic Organ Prolapse

The different types of pelvic organ prolapse are categorized based on the organ they affect. For example:

• Uterine prolapse: A uterine prolapse involves the uterus dropping down into and sometimes protruding from the vagina.
• Anterior vaginal wall prolapse (or cystocele): A vaginal wall prolapse happens when the bladder drops down, pushing against the front wall of the vagina.
• Posterior vaginal wall prolapse (or rectocele): This occurs when the rectum drops down and bulges into the back wall of the vagina.
• Uterovaginal prolapse: A uterovaginal prolapse involves several organs dropping—like the bladder, uterus, and rectum, for example.
• Vaginal vault prolapse: A vaginal vault prolapse happens after a hysterectomy (surgery to remove the uterus), in which the top of the vagina drops down and creates a bulge.

Vaginal Vault Prolapse

Pelvic Organ Prolapse Symptoms

There may be no noticeable symptoms for many people with pelvic organ prolapse. When symptoms do happen, they can include:

• Feeling or seeing a bulge protruding through the vaginal opening
• Feeling pressure, discomfort, or fullness in the pelvic area
• Leaking urine or having difficulty with a bowel movement
• Difficulty inserting tampons
• Sexual dysfunction

What Causes a Pelvic Organ Prolapse?

There are several different causes of pelvic organ prolapse. Two of the most common are pregnancy and childbirth, as these experiences can strain the pelvic floor muscle and connective tissues.

Other causes of POP include:

• Aging
• Hormonal changes during menopause
• Prior pelvic surgery or hysterectomy
• Abdominal pressure or strain from lifting heavy objects, obesity, chronic cough, or constipation
• Family history

How Is Pelvic Organ Prolapse Diagnosed?

A healthcare provider diagnoses pelvic organ prolapse. During an office visit, this typically starts with questions about your symptoms, medical history, and a pelvic exam. This involves the healthcare provider inserting a tool called a speculum inside the vagina so that they can better see the pelvic organs and assess for POP.

In addition, they'll be looking for any POP complications like urinary incontinence, fecal incontinence, or bladder obstruction. Sometimes, an imaging test known as computed tomography (CT) may be ordered in more severe POP cases.

How is Pelvic Organ Prolapse Treated?

There are several different treatment options for pelvic organ prolapse, depending on the type, the severity, and the factors like age and overall health.

The goal of treatment is to relieve symptoms, improve quality of life and sexual function, and prevent a new prolapse from occurring. A healthcare provider may recommend one or a combination of the following options:

• Observation: For mild cases without many symptoms, this involves follow-up visits to ensure the prolapse isn't worsening
• Pessary: A removable device is inserted into the vagina to support any prolapsed organs and ease symptoms
• Surgery: Minimally invasive procedures to support the vagina, uterus, and pelvic floor exist and have shown to be successful in more severe POP cases

Other parts of a treatment plan might include hormone therapy, particularly if you've had a hysterectomy, or pelvic floor exercises (Kegel exercises) to strengthen muscle control in that part of the body.

Research has found that the more patients are educated on at-home care and pessary use, the lower the chances of complications.

Prognosis

Pelvic organ prolapse is not life-threatening—but living with this condition can still be bothersome if you experience symptoms. 

While many people don’t experience symptoms to start, it’s possible to begin to experience bulging that can be pretty uncomfortable. Fortunately, surgery to treat POP is typically successful, with some research showing improvement in symptoms and other issues in follow-up analyses.

Separately, it’s not uncommon for people with POP to experience another pelvic floor disorder, like urinary incontinence, overactive bladder, or fecal incontinence. Experts recommend being routinely screened for these conditions.

Summary

Pelvic organ prolapse (POP) is a common condition in which one of the pelvic organs drops from its usual position and creates a bulge near the vaginal opening. Affected organs include the uterus, cervix, prostate, bladder, urethra, and rectum. This is due to weak or injured pelvic floor muscles and surrounding tissue, which can develop after experiencing pregnancy or childbirth. Treatment options include observation, supportive devices, or surgery.