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POP can happen to people of any sex, but women and people who were assigned as female at birth (AFAB) are more likely to get it. Dropped rectum and bladder can occur in men and people assigned male at birth (AMAB).
Between 3% and 11% of AFAB individuals experience POP while 37% of people between the ages of 60 and 79 experience pelvic floor disorders, including POP. POP does not always result in symptoms which is why it’s difficult to tell how normal POP is among individuals who don’t see their medical services suppliers for alleviating POP’s side effects.
POP or pelvic organ prolapse is a condition that affects women who gave birth naturally. Pregnancy, labor, and childbirth can be tough on a women’s body and POP is just one such issue. It can be fixed with surgical or non-surgical methods so there’s nothing to worry about.
We have brought together the A-Z of pelvic organ prolapse, from its definition to causes, symptoms, treatment options, and more. Keep reading to find out!
Definition of Pelvic Organ Prolapse
Pelvic organ prolapse (POP) is a condition where your pelvic floor (the muscles, tendons, and tissues that help your pelvic organs stay in place) becomes excessively powerless to hold your organs up. Your pelvic floor muscles support your uterus, bladder, rectum, and vagina like a strong sling. These organs move out of place when these muscles become too loose or are damaged.
Organ loss can occur in mild cases of POP. They may cause a bulge outside of your vagina in more severe cases. Along with urinary and fecal incontinence, POP can sometimes coexist with these other disorders.
Tap here to know what a tilted uterus means!
5 Types of Pelvic Organ Prolapse
The organs affected and the location of the pelvic floor weaknesses determine the type of prolapse you have. Here are its different types:
Cystocele (Dropped Bladder)
The most prevalent type of POP is cystocele. Here your bladder bulges onto your vagina because of the weak pelvic muscles right above your vagina. Anterior vaginal wall prolapse is another name for this kind of prolapse.
Urethrocele (Dropped Urethra)
The urethra, the tube that carries urine outside your body, can droop if your pelvic floor muscles are weak. A dropped bladder is frequently accompanied by a dropped urethra.
Rectocele (Dropped Rectum)
Your rectum may bulge onto the back wall of your vagina if you have weak pelvic floor muscles between your rectum and vagina. Posterior vaginal Wall Prolapse is the other name for this kind of prolapse.
Enterocele (Dropped Small Intestine)
Your small intestine may bulge onto the back wall or the top of your vagina due to weak pelvic muscles.
Uterine Prolapse (Dropped Uterus)
Your uterus may fall into your vaginal canal if your pelvic floor is weak.
Vaginal Vault Prolapse (Dropped Vaginal Vault)
The top part of your vagina, or vaginal vault, may fall into your vaginal canal if you have weak pelvic floor muscles.
Symptoms of Pelvic Organ Prolapse
Feeling like something is falling out of your vagina is the most common sensation for someone with pelvic organ prolapse. Other signs include:
- Vaginal swelling, fullness, or pressure
- Your pelvis feels full, pressured, or aching
- Aches or discomfort in your low back
- During sexual activity, pressure, the sensation of hitting, or pain (dyspareunia)
- A pressure that gets worse throughout the day.
- A pressure that gets worse if you cough or stay on your feet for too long
- Having to move organs that are protruding with your finger in order to urinate or poop
- Spotting in the womb
Your symptoms are affected by the location of your prolapse. When you tell your doctor about your symptoms, they can find the areas of your pelvic floor that are weakest. Due to their similar risk factors, stress incontinence, urinary incontinence, and bowel incontinence frequently coexist with POP. The signs include:
- Stress incontinence, leaking urine while exercising, laughing, or coughing
- Urge incontinence, a regular inclination to pee that is difficult to control
- Fecal incontinence, also known as constipation or inability to control your bowel movements
Causes of Pelvic Organ Prolapse
So, what causes the prolapse of the pelvic organs?
- Prolapse is more likely if your pelvic floor is weak and the most common cause of POP is vaginal birth. Your pelvic floor muscles are more likely to sustain injuries that could result in POP if you have multiple vaginal deliveries, twins or triplets, or a larger-than-average fetus (fetal macrosomia).
- Another cause of POP is the weakening of your pelvic floor muscles, as well as other muscles in your body, as you get older. Decreasing estrogen is a factor in weakening pelvic muscles during old age. Your body produces less estrogen during menopause. The decline has the potential to weaken the connective tissues that support your pelvic floor.
- POP is more likely to occur in people who are clinically overweight or obese than in people who are in the normal weight range.
- Your pelvic floor muscles may become weaker as a result of long-term abdominal pressure during frequent heavy lifting, chronic constipation, and coughing.
- The family background of POP might put you at risk of an impending prolapse.
- The genetic causes of POP are still being studied, but it’s possible that you were born with a weaker pelvic floor.
- Your risk of developing POP is increased by collagen irregularities that weaken the connective tissues in your pelvic floor. People who have connective tissue disorders like Ehlers-Danlos Syndrome are more likely to develop POP if their joints move more.
Diagnosis of Pelvic Organ Prolapse
How is pelvic organ prolapse diagnosed and tested? Your healthcare provider will examine your pelvis and go over your symptoms during your appointment. Your healthcare provider may ask you to cough during the exam so that they can determine the full extent of your prolapse when you are relaxed and when you are exerting yourself. They may also examine you while you are standing or lying down. A pelvic exam is frequently all that is required to diagnose a prolapse.
Other tests for POP diagnoses might include:
- Your doctor can look for symptoms of urinary problems that are common with POP with bladder function tests.
- A cystoscopy, which allows your doctor to look inside your bladder and urethra, may be one of the tests.
- A urodynamics test, which measures how well your bladder and urethra store and release urine, may also be performed by your doctor.
- Imaging procedures that let your doctor or nurse look inside your pelvis.
- In order to determine the extent of your prolapse, your doctor may order an MRI or ultrasound of the pelvic floor.
What is The Pelvic Organ Prolapse Staging System?
The Pelvic Organ Prolapse Quantification (POP-Q) system divides POP into mild, moderate, and severe categories. The scale has a value from 0 to 4. Your organs have not shifted at all during Stage Zero. You have a complete prolapse in Stage 4. The severest type is a complete prolapse. It might involve a body organ protruding. Your treatment will be influenced by the type and extent of your prolapse.
Treatment of Pelvic Organ Prolapse
1. Non-surgical Treatments
Nonsurgical procedures are typically the first line of treatment for POP because any surgical procedure may have risks or complications. On the off chance that more safe medicines don’t work, your supplier might suggest a medical procedure.
Non-surgical treatments include:
- Pessary in the womb: Pessary is a silicone device that can be removed and inserted into your vagina by your doctor to keep a sagging organ in place.
- Kegel exercises: You may be referred to a physical therapist by your doctor to have targeted muscle-training exercises and muscle-strength tests done. Kegel exercises are just one such physical therapy.
2. Surgical Treatments
Surgery may be an option if you don’t want to have children and your symptoms haven’t gone away with conservative treatments. After surgery, giving birth might make it more likely that your prolapse will come back.
There are two types of surgeries: reconstructive and obliterative surgery. The parts of your pelvic floor that are weak are fixed with reconstructive surgery. Your vaginal walls are sewn shut during obliterative surgery, preventing organs from escaping.
- Colpocleisis: The obliterative procedure known as colpocleisis results in a shorter vagina. It prevents any organs in your body from bulging outward. If you are too weak for reconstructive surgery and no longer want to have penetrative sex, this is a good option for you.
- Colporrhaphy: Prolapse of the anterior or posterior vaginal wall is treated with colporrhaphy. Your healthcare provider will carry out the surgery through your vagina with colporrhaphy. Dissolvable sutures are used to reinforce the walls of your vagina to support your bladder and rectum.
- Sacrocolpopexy: It treats enterocele and vaginal vault prolapse. Laparoscopy, a less invasive procedure, or an abdominal incision may be used during the treatment. Your provider will first attach a surgical mesh to your tailbone and then to your vaginal walls during the procedure to shift your vagina back into place.
- Sacrohysteropexy: Uterine prolapse is treated with sacrohysteropexy. Your provider lifts your uterus into place by securing surgical mesh to your tailbone, cervix, and vagina. If you don’t want a hysterectomy, which removes your uterus, you can have sacrohysteropexy.
- Sacrospinous or Uterosacral Ligament Fixation: Your tissues are utilized during sacrospinous or uterosacral ligament fixation to treat vaginal vault prolapse or uterine prolapse. It is performed through your vagina, like colporrhaphy. Dissolvable sutures are used to connect the top of your vagina to a pelvic muscle or ligament during the procedure. Native tissue repair is a term used to describe this kind of surgery.
During your POP surgery, your provider may suggest additional procedures. For instance, in order to access and repair pelvic floor muscles, some procedures may necessitate a hysterectomy. During surgery, your provider might treat other conditions like stress urinary incontinence that come with POP.
Prevention of Pelvic Organ Prolapse
You cannot control most POP causes. But you can lower your risk by developing healthy habits.
- Exercise your pelvic floor every day. Stronger support for your organs comes from having control over your pelvic floor muscles.
- Keep a healthy body weight. Discuss with your provider what it means for you to be a healthy weight.
- Prevent bloating. Your pelvic floor muscles can be strained by persistent constipation. Constipation can be avoided by following a diet high in fiber and drinking plenty of fluids.
- Avoid smoking. Chronic coughing caused by smoking can put too much pressure on your abdomen and strain your pelvic floor muscles.
- When lifting heavy things, protect your pelvic floor. Get assistance lifting heavy items. Squat with your hips and knees bent while keeping your back as straight as possible when lifting alone. When lifting, don’t twist your torso. Your pelvic floor and low back are both protected when you properly position your body.
Your goals (having children, continuing to have penetrative sex, undergoing less invasive surgery, etc.) and your prolapse (where it is located, how severe it is) all play a role in your prognosis. Discuss with your doctor how your prolapse affects your treatment options. Ask about any risks that could prevent you from achieving your goals and how the benefits of treatment will help you do so. Your POP experience will be enhanced if you base your expectations on honest conversations with your provider.
When to See a Doctor for Pelvic Organ Prolapse?
Your symptoms and prolapse may get worse if you don’t get help. If your prolapse progresses to the point where it is affecting your quality of life, your healthcare provider can monitor it and suggest treatments. Which should you enquire about POP?
- What kind of POP am I using?
- Will I need surgery to manage my POP symptoms?
- To treat my POP, what surgical options are available?
- What are my chances of success with the POP surgical options I have?
- How likely is it that surgery will alleviate all of my symptoms?
- What kinds of negative effects might surgery have?
- Will treatment affect my sexual life?
A Final Word on Pelvic Organ Prolapse
Prolapsed pelvic organs can affect your sexuality and body image. It can give you symptoms that make it hard to live life to the fullest. However, you do not have to accept POP. If you have symptoms of POP or suspect you have a weak pelvic floor, don’t be afraid to talk to your doctor. They can suggest treatments, medical devices, and even changes to your way of life that can fix your prolapse and make your life better.