Pelvic Organ Prolapse: What It Is and How to Treat It
Pelvic organ prolapse is a condition that affects the quality of life for many people, especially as they age.
During their lifetime, women have a 20% risk of undergoing surgery for pelvic organ prolapse (source: Obstetrics & Gynecology), and the rate of prolapse that doesn’t require surgery is much higher. In fact, many people with prolapse might not even know they have it or aren’t bothered enough by their symptoms to see their doctor. Read on to learn more about what pelvic organ prolapse is, what its symptoms are, and how to treat it.
What is pelvic organ prolapse?
Pelvic organ prolapse, often simply called prolapse or POP, occurs when the ligaments and muscles that support the pelvic floor become weak or loose, allowing the pelvic organs to droop into the pelvis and even protrude outside the body.
If you have POP, your pelvic organs might protrude outside your body all the time, or only during physical exertion that increases intra-abdominal pressure, like carrying or pushing something heavy or having a bowel movement. Your doctor will call your prolapse by a different name depending on which organs are affected.
Posterior vaginal prolapse (rectocele)
This type of prolapse occurs when the rectum or intestines bulge into the back of the vagina. Your rectum is the last part of your large intestine, closest to your anus. When the tissue supporting your rectum weakens or detaches, your rectum can bulge into the back wall of the vagina. If you have a rectocele, your symptoms may vary from only minor pain and constipation to severe symptoms, such as the rectum bulging through the vaginal opening.
Anterior vaginal prolapse (cystocele)
This type of prolapse occurs when the bladder sags and presses against the front wall of the vagina. Cystocele is the most common type of prolapse, and it accounts for more than 50% of cases. Symptoms include feeling a frequent need to urinate, feeling like you haven’t emptied your bladder after urinating, and frequent urinary tract or bladder infections.
Other types of prolapse
Other less common types of pelvic organ prolapse include:
- Uterine prolapse (hysterocele), which occurs when the uterus drops into the vagina
- Urethral prolapse (urethrocele), which occurs when the tissue around the urethra drops into the vagina
- Small bowel prolapse (enterocele), which occurs when the small intestine drops into the vagina
These types of prolapse would typically occur at the same time as a bladder or rectal prolapse. In addition to distinguishing prolapse by the affected organs, the condition can also be graded or staged according to severity.
The Baden-Walker system assigns grades from 0 to 4 based on the extent of the protrusion and weakness of the pelvic organs. Grade 0 indicates no prolapse and grade 4 indicates the maximum possible prolapse for each organ.
The Pelvic Organ Prolapse Quantification (POP–Q) system assigns stages from 0 to IV based on the distance between any prolapsed organs and the hymen.
Pelvic floor therapy has been proven to help treat stage I and II prolapse (source: Inserm). Surgery is generally required to treat stages III and IV.
What are the symptoms of prolapse?
If you have POP, you might notice a bulge at the opening of your vagina. If the condition is still in the early stages, you might only experience discomfort during physical activity (exercising, coughing, or heavy lifting), and the discomfort might go away when you stop the activity. Everyone’s body is different, and symptoms can vary depending on the type of prolapse and stage or grade of the condition. Symptoms tend to get worse over time.
Here are just a few of the most common symptoms of POP:
Vaginal pressure
People with POP frequently complain that it feels like something is pushing on their vagina or that they feel a “bulge.” If the bulge is located more toward the front, it could point to a cystocele; if it is located toward the back, it could be a rectocele.
Pelvic pressure
People with POP also frequently report a sensation of pressure in their pelvis or abdomen. You may also feel pressure on your perineum or rectum, or like your bladder, uterus, or rectum has dropped. If you feel discomfort around your labia, like you’re wearing a tampon that has slipped out of place, your cervix may have dropped into your vagina.
Trouble urinating and with bowel movements
People with POP often have symptoms related to urinating and bowel movements. Talk to your doctor if you feel like you’re unable to empty your bladder, if you’re constipated, or if you’re leaking urine (urinary incontinence). These can be the first signs of prolapse and can help your doctor make the right diagnosis.
At the earliest stages, only 1 in 10 people with POP will even notice they have it. They might not notice any symptoms at first, but these can worsen with time and age. No two conditions progress the same way. Genetics can also play a role: some people are born with weaker connective tissue and are therefore at a higher risk for prolapse.
According to a study published in the International Urogynecology Journal, up to 50% of women were found to have pelvic organ prolapse upon vaginal examination. Unfortunately, the topic is still taboo, and many people are too embarrassed to talk to their gynecologist or primary care provider about their symptoms. You should contact your provider at the first signs of prolapse to diagnose (or rule out) the condition and treat it as early as possible.
Vaginal pressure
People with POP frequently complain that it feels like something is pushing on their vagina or that they feel a “bulge.” If the bulge is located more toward the front, it could point to a cystocele; if it is located toward the back, it could be a rectocele.
Pelvic pressure
People with POP also frequently report a sensation of pressure in their pelvis or abdomen. You may also feel pressure on your perineum or rectum, or like your bladder, uterus, or rectum has dropped. If you feel discomfort around your labia, like you’re wearing a tampon that has slipped out of place, your cervix may have dropped into your vagina.
Trouble urinating and with bowel movements
People with POP often have symptoms related to urinating and bowel movements. Talk to your doctor if you feel like you’re unable to empty your bladder, if you’re constipated, or if you’re leaking urine (urinary incontinence). These can be the first signs of prolapse and can help your doctor make the right diagnosis.
At the earliest stages, only 1 in 10 people with POP will even notice they have it. They might not notice any symptoms at first, but these can worsen with time and age. No two conditions progress the same way. Genetics can also play a role: some people are born with weaker connective tissue and are therefore at a higher risk for prolapse.
According to a study published in the International Urogynecology Journal, up to 50% of women were found to have pelvic organ prolapse upon vaginal examination. Unfortunately, the topic is still taboo, and many people are too embarrassed to talk to their gynecologist or primary care provider about their symptoms. You should contact your provider at the first signs of prolapse to diagnose (or rule out) the condition and treat it as early as possible.
What are the risk factors for prolapse?
Several factors increase the likelihood that your pelvic organs might droop into your vaginal wall, especially ones that increase intra-abdominal pressure and weaken the pelvic floor. Being aware of these risk factors can help you take steps to prevent prolapse before it starts.
Pregnancy and vaginal delivery
One of the main risk factors for prolapse is vaginal birth, which can injure the pelvic floor, especially during difficult or assisted deliveries or when delivering a baby that weighs more than 8 pounds 13 ounces. Your doctor may do an episiotomy, a surgical incision in the perineum, to make vaginal birth easier. Episiotomy reduces the risk of perineal tears during childbirth, but not the risk of prolapse later in life. Multiple pregnancies are also a risk factor, as the risk of prolapse increases with each successive pregnancy.
Age and menopause
Hormones dictate much of your life. This is especially true as you age. Hormone levels (especially estrogen) drop off during menopause, altering the strength and elasticity of your pelvic floor muscles. As you get older, your pelvic organs gradually lose internal support, which increases the chances they’ll drop or even bulge outside of your body.
Intra-abdominal pressure
A variety of factors that increase pressure in your abdomen can affect the tone of your pelvic floor muscles and lead to prolapse.
Overweight and obesity
Carrying excess weight creates more pressure in your abdomen, increasing the stress on your pelvic muscles.
Constipation and chronic coughing
Frequent coughing or sneezing from seasonal allergies or bronchitis causes repeated stress that can weaken your fragile pelvic floor muscles. The same goes for chronic coughing caused by other factors, like smoking. If you’re often constipated, frequent straining increases the risk of prolapse.
Strenuous physical activity
Vigorous exercise can increase the risk of prolapse, especially when your pelvic floor is weak, such as right after childbirth. Certain types of exercise put more stress on the pelvic floor, which is why high-level athletes are often at higher risk.
Heavy lifting, either as part of your exercise routine or your job (for example, if you’re a nurse, caregiver, or warehouse worker) can also put you at greater risk. People who are on their feet all day, such as teachers and cashiers, also have a greater chance of developing prolapse.
Overweight and obesity
Carrying excess weight creates more pressure in your abdomen, increasing the stress on your pelvic muscles.
Constipation and chronic coughing
Frequent coughing or sneezing from seasonal allergies or bronchitis causes repeated stress that can weaken your fragile pelvic floor muscles. The same goes for chronic coughing caused by other factors, like smoking. If you’re often constipated, frequent straining increases the risk of prolapse.
Strenuous physical activity
Vigorous exercise can increase the risk of prolapse, especially when your pelvic floor is weak, such as right after childbirth. Certain types of exercise put more stress on the pelvic floor, which is why high-level athletes are often at higher risk.
Heavy lifting, either as part of your exercise routine or your job (for example, if you’re a nurse, caregiver, or warehouse worker) can also put you at greater risk. People who are on their feet all day, such as teachers and cashiers, also have a greater chance of developing prolapse.
How is prolapse treated?
If you have pelvic organ prolapse, there are several ways to treat it, depending on how severe it is, how much it’s affecting your daily life, and, most importantly, what effect treatment will have on your quality of life. Your doctor may recommend several different options.
First line of treatment: pelvic floor therapy
Surgery is not always necessary to treat drooping pelvic organs. The first treatment your doctor may recommend for prolapse is pelvic floor physical therapy. Working to tone and strengthen your pelvic floor can significantly improve pelvic organ prolapse and keep it from getting worse, helping to eliminate or delay the need for surgery.
Kegel exercises for strengthening the pelvic floor
For first-degree (minor) prolapse, regular pelvic floor exercises supervised by a medical professional may be all you need to treat and reverse the condition. Pelvic floor exercises, commonly known as “Kegels,” involve repeatedly contracting and relaxing your pelvic muscles. Repeating and gradually lengthening the contractions helps strengthen the muscles in your pelvic floor. Toning these muscles helps keep your organs in the correct position to prevent prolapse. Pelvic floor exercises can also help with other issues, like leaking urine.
Pelvic floor trainers
A range of devices can help you do pelvic floor exercises at home:
- Electrical stimulation devices – These devices use electrodes and electrical pulses to stimulate the pelvic floor, so you don’t have to actively contract your pelvic floor muscles.
- Biofeedback devices – These usually consist of a device that you insert into your vagina. The device connects to a screen, allowing you to visualize and measure contractions in real time to encourage active contraction. Some devices even connect to mobile apps, so you can see how you’re doing on your smartphone.
Proven effectiveness of biofeedback
Biofeedback lets you visualize active pelvic muscle contractions in real time. It’s a tried-and-true technique for mastering muscle contractions that health care professionals recommend for pelvic floor therapy. Biofeedback gives you visual (or audio) cues to build a mind-muscle connection with muscles you can’t see and that can be difficult to feel. Practicing active contractions helps you develop the reflexes you need for your everyday life, like contracting your muscles to brace your pelvic floor when you cough.
Biofeedback devices are more effective and more likely to be used because they aren’t painful. There’s another advantage, too: pelvic floor exercises can be gamified to create fun experiences that help motivate you to stick with your therapy long term. You can even track your progress over time using the data biofeedback devices provide.
Emy, a medical device for at-home pelvic floor training
The key to keeping your pelvic floor strong is regular training. Strengthening your pelvic floor, just like any other part of your body, is a lifelong pursuit. The Emy biofeedback device was developed specifically for long-term use. It features a fun mobile app that connects to a biofeedback bulb you place in your vagina. It was designed to work the pelvic floor in a variety of positions—lying down, sitting up, and even standing—to train your muscles by simulating different real-world scenarios.
Fun Kegel training at home
The Emy app’s gamified exercises are backed by medical science and modeled after the PERFECT Scheme. The app uses AI to tailor the difficulty of each exercise based on your current strength and past training results, helping you make progress over time. Plus, Emy has been clinically proven to be effective for people with stress urinary incontinence if used for at least 3 months:
- 98% of users had significantly improved quality of life
- 87% of users reported less frequent and milder incontinence
- 96% of users were satisfied with their Emy Kegel trainer exercises
Tailored exercises chosen by your health care provider
The Emy app provides a range of effective exercises to teach you the following types of contractions for better overall pelvic health:
- Long-hold contractions
- Timed, repeated contractions
- Bursts of quick contractions
These are the same contractions you’d learn during a pelvic floor physical therapy session with a physical therapist, OB-GYN, or midwife. With Emy, your provider can tailor your at-home training plan by selecting the best exercises for you, like they would at an in-person appointment. Emy is a solution for effective, targeted pelvic muscle training from the comfort of your home, with real-time progress monitoring that you can share with your provider at your next appointment.
Proven effectiveness of biofeedback
Biofeedback lets you visualize active pelvic muscle contractions in real time. It’s a tried-and-true technique for mastering muscle contractions that health care professionals recommend for pelvic floor therapy. Biofeedback gives you visual (or audio) cues to build a mind-muscle connection with muscles you can’t see and that can be difficult to feel. Practicing active contractions helps you develop the reflexes you need for your everyday life, like contracting your muscles to brace your pelvic floor when you cough.
Biofeedback devices are more effective and more likely to be used because they aren’t painful. There’s another advantage, too: pelvic floor exercises can be gamified to create fun experiences that help motivate you to stick with your therapy long term. You can even track your progress over time using the data biofeedback devices provide.
Emy, a medical device for at-home pelvic floor training
The key to keeping your pelvic floor strong is regular training. Strengthening your pelvic floor, just like any other part of your body, is a lifelong pursuit. The Emy biofeedback device was developed specifically for long-term use. It features a fun mobile app that connects to a biofeedback bulb you place in your vagina. It was designed to work the pelvic floor in a variety of positions—lying down, sitting up, and even standing—to train your muscles by simulating different real-world scenarios.
Fun Kegel training at home
The Emy app’s gamified exercises are backed by medical science and modeled after the PERFECT Scheme. The app uses AI to tailor the difficulty of each exercise based on your current strength and past training results, helping you make progress over time. Plus, Emy has been clinically proven to be effective for people with stress urinary incontinence if used for at least 3 months:
- 98% of users had significantly improved quality of life
- 87% of users reported less frequent and milder incontinence
- 96% of users were satisfied with their Emy Kegel trainer exercises
Tailored exercises chosen by your health care provider
The Emy app provides a range of effective exercises to teach you the following types of contractions for better overall pelvic health:
- Long-hold contractions
- Timed, repeated contractions
- Bursts of quick contractions
These are the same contractions you’d learn during a pelvic floor physical therapy session with a physical therapist, OB-GYN, or midwife. With Emy, your provider can tailor your at-home training plan by selecting the best exercises for you, like they would at an in-person appointment. Emy is a solution for effective, targeted pelvic muscle training from the comfort of your home, with real-time progress monitoring that you can share with your provider at your next appointment.
Treating prolapse without surgery
Pelvic floor exercises can reduce the uncomfortable symptoms of prolapse and urinary incontinence and keep them from getting worse. Your doctor might also recommend other nonsurgical treatments, such as a pessary. Pessaries come in a variety of shapes and are inserted into the vagina to support the pelvic floor and prolapsed organs while you wait for surgery. Pessaries are removable and essentially ease prolapse symptoms without treating the root cause. Hormone therapy is another nonsurgical way to treat symptoms related to menopause.
Treating prolapse with surgery
If your prolapse is severe and your quality of life has deteriorated, your doctor may recommend the following surgical options based on your level of discomfort and your urodynamic testing results:
- Abdominal surgery – Your doctor makes an abdominal incision and places artificial materials to support your organs
- Vaginal surgery – Your doctor removes excess tissue to tighten the pelvic floor
- Surgical removal – Your doctor removes the uterus (hysterectomy) or ovaries (oophorectomy), particularly if you’re older
Living with prolapse
If your symptoms don’t bother you, you can live with prolapse without treating it. However, symptoms tend to get worse over time. Symptoms include:
- Urinary incontinence
- Urinary tract infections
- Constipation
- Bleeding or pain during intercourse
Let your doctor know if you develop new symptoms, as it could mean that your condition is getting worse.
How do I prevent pelvic organ prolapse?
The easiest way to prevent pelvic organ prolapse is lifelong, regular training to keep your pelvic floor strong so it holds your organs in place. If you’re in a high-risk group, your doctor might recommend preventive pelvic floor therapy.
Here are a few more tips to help prevent prolapse:
- Eat a balanced diet to maintain a healthy weight
- If you’re pregnant, talk to your provider about ways to maintain a healthy pregnancy weight and discuss how to reduce the risk of unnecessary vaginal trauma
- Do pelvic floor physical therapy after giving birth
- Do health-appropriate exercise and replace exercises that put too much stress on your pelvic floor with easier ones
- Avoid heavy lifting
- Take steps to avoid constipation and treat chronic constipation
Now you have all the tools you need to take control of your pelvic floor health and prevent prolapse. Talk to a trusted health care professional if you have any questions.