Written by Laura Justin, Physiotherapist in Australia
How many women are affected?
Pelvic Organ Prolapse (POP) refers to the descent of the pelvic organs - the bladder, uterus, rectum or bowel down into the vaginal walls, or in some cases, out of the vagina.
Current statistics show that 1 in 3 women will experience prolapse at some point in their lives. Though it is so common, it is rarely spoken about! Pelvic Organ Prolapse is nothing to be ashamed of, it is a common part of the journey of being a woman warrior! However, it is also something that can cause discomfort and, luckily, that is something that can often be easily managed.
Why does an organ prolapse?
Imagine the pelvic floor muscles as being a hammock that sits at the bottom of your pelvic cavity, under your pelvic organs (2). Organ prolapse occurs when the connective tissue (muscles and ligaments) of the pelvic floor become stretched, weak or damaged and can no longer adequately hold the pelvic organs up in their usual position inside the pelvis, especially when inta-abdominal pressure is applied (1). One or more of the organs then moves down towards the vagina.
How does it feel inside?
Pelvic Organ Prolapse is often described as a heaviness or bulge in the vagina. It may also be experienced as a dragging, sagging or dropping of the organs into the vaginal space. It may also be accompanied by urinary or bowel symptoms, or painful sex depending on the organ affected.
The tissue that may be felt or seen is actually the vaginal wall itself, being pushed by one of the organs.
Bladder (anterior vaginal wall) prolapse symptoms
Difficulty emptying the bladder
Weak stream of urine
Frequent UTIs
Uterine prolapse
Deep pain during sexual intercourse
Changes in sexual sensation
Bowel (posterior vaginal wall prolapse):
Difficulty emptying your bowel
What can cause Pelvic Organ Prolapse?
Pregnancy; due to the weight of the baby during pregnancy and hormonal changes
Menopause - due to reduction in hormones that support connective tissue
Birth; large pressure on the pelvic floor and possible injury
Straining; chronic constipation and straining can overload the pelvic floor structure and result in pelvic organ prolapse.
The Different Grades:
If you have a prolapse, an examination from your reproductive health professional can determine the extent of your prolapse:
Grade 1 = Prolapsed organ does not reach the vulva.
Grade 2 = Prolapsed organ reaches the vulva but does not come out.
Grade 3 = Prolapsed organ reaches the vulva, comes out a bit but can be pushed in with a touch.
Grade 4 = Prolapsed organ reaches the vulva, comes out a bit and cannot be pushed in with a touch.
Management Strategies for Pelvic Organ Prolapse
For Grade 1-2 Prolapse:
Strengthening pelvic floor muscles can reduce symptoms
Avoiding constipation, strenuous lifting and exercise and straining
Use of insertable devices such as Pessaries or tampons to support the vaginal walls
Note: spending time laying down with legs elevated can reduce acute symptoms
For Grade 3-4 Prolapse:
For prolapse that descends outside the vagina and is symptomatic for the woman, surgical management is often indicated.
There are various surgical options that can help to support the pelvic organs or vaginal wall in place, or that remove the uterus (hysterectomy) to reduce pressure in uterine prolapse.
Speak to your Gynaecologist or Women’s Health Physiotherapist about the best options for your symptoms.