Key Points about Pelvic Organ Prolapse (POP)

Pelvic organ prolapse occurs when the normal pelvic muscles and ligaments stretch or weaken, causing one or more pelvic organs to drop out of place and bulge into or through the vaginal opening.
POP is extremely common, affecting approximately one-third to one-half of all women who have given birth.
It can involve the bladder (anterior wall), uterus (vaginal apex), bowel/rectum (posterior wall), or the top of the vagina after a hysterectomy (vaginal vault prolapse).
The severity of pelvic organ prolapse can vary widely, and range from mild displacement to a severe protrusion outside the vaginal opening.

Pelvic organ prolapse causes

Lots of things can contribute to pelvic organ prolapse, including:

Aging and natural tissue changes after menopause
History of pregnancy and vaginal childbirth (especially prolonged pushing or having larger babies)
Chronic conditions that increase abdominal pressure, like chronic constipation
Frequently lifting heavy things
Having obesity or being overweight
Prior pelvic surgery, like a hysterectomy
Genetic factors

Pelvic organ prolapse symptoms

Symptoms of POP can include:

A distinct sensation of pelvic fullness, heaviness, or "dragging" in the pelvis or vagina.
A noticeable lump, bulge, or protrusion extending into or out of the vaginal opening (which can be worse after standing for long periods).
Having difficulty urinating, like a slow urine stream, a frequent or urgent need to go or feeling like the bladder isn't emptying completely.
Bowel symptoms, including chronic constipation, straining or the need to manually press on the vaginal wall (splinting) to complete a bowel movement.
Discomfort, a feeling of obstruction or a lack of support during sexual intercourse.

Pelvic organ prolapse diagnosis

Your doctor will do a comprehensive review of your pelvic history, childbirth history and daily symptom patterns. They will perform a specialized physical exam while resting and while straining (bearing down) to identify which organs are dropping and to measure the exact stage of the prolapse.

They also may evaluate how well your bladder empties (called a post-void residual check) and to rule out concurrent issues like urinary tract infections or urinary retention.

Pelvic organ prolapse treatment

Treating POP can include:

Observation: regular tracking and monitoring for mild, asymptomatic prolapses that do not disrupt your daily life.
Lifestyle modifications: optimizing fiber and fluid intake to manage constipation, maintaining a healthy weight and avoiding heavy lifting.
Pelvic floor physical therapy: guided exercises with a specialized therapist to strengthen the underlying muscles and reduce mild to moderate symptoms.
Vaginal pessary: a customized, removable silicone device fitted in the office that sits inside your vagina to physically support the prolapsed organs.
Surgical repair: advanced minimally invasive or vaginal procedures designed to restore your natural anatomy, reconstruct support or suspend the dropped organs.

When to seek care for pelvic organ prolapse

If you experience a persistent feeling of pelvic pressure, a visible vaginal bulge, or feel a physical mass when wiping or bathing.
If you have to manually assist or alter your position to completely empty your bladder or pass a bowel movement.
If physical discomfort or self-consciousness about the bulge is impacting your exercise, intimate relationships or overall quality of life.

Pelvic Organ Prolapse (POP)