Pelvic Organ Prolapse: Types, Symptoms, and Treatments

Pelvic organ prolapse (aka POP) is a common condition that many people experience but often feel uncomfortable discussing. Understanding the types, symptoms, and treatment options can help you recognise early signs and make informed decisions for your wellbeing.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the muscles and ligaments supporting the pelvic organs lose strength. As a result, one or more pelvic organs - such as the bladder, uterus, rectum or vagina drop from their normal position and bulge into the vagina. This condition affects millions of women, especially after childbirth, menopause or surgery.

Pelvic organ prolapse can affect daily activities, comfort, and quality of life. Recognising the symptoms and understanding your options are key to managing this issue effectively.

Types of Pelvic Organ Prolapse

There are several distinct types of pelvic organ prolapse, each named for the organ involved. Each type has unique symptoms and implications:

Cystocele (Bladder Prolapse)

Cystocele occurs when the bladder drops into the anterior or front wall of the vagina. This is the most common type of pelvic organ prolapse.

Uterine Prolapse

The uterus drops down into the vaginal canal.

Rectocele (Rectal Prolapse)

The rectum or part of the large intestines bulge into the posterior or back wall of the vagina. Rectal prolapse may look or feel like haemorrhoids but don't go away on their own.

Enterocele (Small Bowel Prolapse)

The small intestine presses against and creates a bulge in the vaginal wall or top of the vagina.

Vaginal Vault Prolapse

The top of the vagina descends into the vaginal canal, often after a hysterectomy.

Urethrocele

This occurs when the urethra drops and is often occurs in conjunction with bladder prolapse. 

Each type can occur on its own or alongside others, depending on the individual’s anatomy and risk factors.

Causes and Risk Factors

Pelvic organ prolapse is primarily caused by the weakening or stretching of the pelvic floor muscles and connective tissue. Several factors increase the likelihood of developing this condition:

• Pregnancy and Childbirth: Vaginal deliveries, especially with large babies or multiple births, strain the pelvic tissues.
• Aging and Menopause: Decreased estrogen weakens pelvic support structures.
• Obesity: Carrying excess weight puts pressure on the pelvic floor.
• Chronic Constipation: Frequent straining increases risk.
• Hysterectomy: Removal of the uterus may affect pelvic organ support.
• Heavy Lifting: Regularly lifting heavy objects may stress pelvic muscles.

Lifestyle, genetics, and overall health also play roles, so being aware of these factors helps in both prevention and early detection.

Recognising the Symptoms

Symptoms of pelvic organ prolapse can vary from mild to severe, depending on the organs involved and the extent of descent. Many women initially overlook mild symptoms, attributing them to aging or other issues. Common signs include:

• A feeling of heaviness or pressure in the pelvis or vagina
• Sensation of something "falling out" or a distinct bulge at the vaginal opening
• Urinary symptoms, including leakage, frequent urge to urinate, or incomplete emptying
• Difficulty having bowel movements or a feeling of rectal fullness
• Discomfort or pain during intimacy
• Lower backache

Symptoms tend to be more noticeable after standing for extended periods, lifting, or at the end of the day. Early recognition and prompt management can greatly reduce discomfort and prevent progression.

Diagnosis and Medical Evaluation

If you notice symptoms of pelvic organ prolapse, it’s important to consult a healthcare provider. Diagnosis often involves:

• Medical history: Discussion of symptoms, childbirth, surgeries, and other risk factors
• Physical examination: A pelvic exam to assess organ position and muscle strength
• Additional tests: In some cases, imaging such as ultrasound or MRI, or tests for bladder function, may be recommended

Early diagnosis leads to more effective and less invasive treatment options, so don’t delay seeking help if you notice changes.

Treatment Options for Pelvic Organ Prolapse

There are several treatment choices for pelvic organ prolapse, tailored to the severity of symptoms, age, general health, and future family plans. For some, simple lifestyle changes may be enough, while others require targeted therapies or surgery.

Conservative Approaches

Many people find relief with non-surgical strategies, especially when prolapse is mild to moderate:

• Pelvic Floor Exercises (Kegels): Regular strengthening of the pelvic muscles that support the pelvic organs can reduce symptoms. These exercises are known as kegel exercises and when performed regularly they improve pelvic floor strength. Consider guidance from a pelvic physiotherapist to ensure the correct muscles are being engaged when performing these exercises. A range of weighted kegel balls and app-enabled or electronic trainers can also provide guided exercises and feedback.
• Lifestyle Modifications: Maintaining a healthy weight, managing constipation and avoiding heavy lifting can ease pressure on the pelvic floor.
• Pessary Devices: A pessary is a soft, removable device inserted into the vagina to hold organs in place. Fitted by a healthcare provider, it allows women to remain active with minimal discomfort.
• Prolapse Sponges: Prolapse sponges are removable devices inserted into the vagina to provide support for the pelvic organs. They may be useful when temporary support is required to perform activities such as exercise or when lifting. 

Hormone Therapy

During menopause, local estrogen therapy may improve pelvic tissue health, potentially reducing symptoms. This option is typically used alongside other therapies rather than as a stand-alone treatment.

Surgical Treatments

When other methods are ineffective or symptoms are severe, pelvic organ surgery may be suggested. Some of the surgical interventions include:

• Vaginal Repair Procedures: Surgeons reinforce weakened tissues to support pelvic organs.
• Colpopexy: The vaginal canal is attached to a ligament or the sacrum to restore support.
• Hysterectomy: Removal of the uterus is sometimes performed, especially if that organ is prolapsing. Additional repairs may address multi-organ involvement.

Surgical decisions depend on your age, health, childbearing wishes, and the type of prolapse. Always discuss risks, benefits, and recovery expectations with your healthcare provider.

Prevention and Self-Care Tips

Preventing pelvic organ prolapse often comes down to protecting the strength and function of your pelvic floor throughout life. Proactive steps can help, regardless of age:

• Practice regular pelvic floor exercises to maintain muscle tone
• Eat a fiber-rich diet to combat constipation and straining
• Stay active, and keep a healthy weight to reduce abdominal pressure
• Use proper lifting techniques, bending from the knees and not the waist
• Address chronic coughs and respiratory issues to limit pelvic stress

Regular medical check-ups can catch early signs, and discussing any new pelvic symptoms with your doctor is always wise.

Living with Pelvic Organ Prolapse

A diagnosis of pelvic organ prolapse can feel daunting, but remember, you’re not alone and prolapse is a very common health issue. Many people live full, active lives with proper management and support. If you notice changes or have concerns, it's important to talk to a healthcare provider.