Pelvic organ prolapse (POP) is a type of pelvic floor disorder that occurs when the muscles and tissues that normally support the pelvic organs (which include the uterus and cervix, bladder and urethra, vagina, small bowel and rectum) become weak or loose. As a result, one or more of these organs drops down into – or even out of – the vagina.
Normally, the pelvic muscles and connective tissues (called fascia) support the pelvic organs like a hammock. When these muscles and tissues are weak or damaged, they can no longer support the pelvic organs. This is what causes POP.
The most common types of pelvic organ prolapse are:
- Cystocele: When the bladder drops into or out of the vagina; it is the most common type of pelvic organ prolapse
- Rectocele: When the rectum bulges into or out of the vagina
- Uterine prolapse: When the uterus (womb) drops into or out of the vagina
- Enterocele: When part of the small intestine bulges into the vagina
- Urethrocele: When the female urethra (the tube that carries urine from the bladder to outside the body) protrudes into the vagina (urethroceles often happen at the same time as cystoceles)
- Vaginal vault prolapse: When the upper part of the vagina sags or drops down into the vaginal canal or outside the vagina (this can happen alone or along with prolapse of other pelvic organs)
Pelvic organ prolapse is quite common in women, especially as they get older. In fact, an estimated 50% of women over age 50 have this condition. The most common risk factors for POP are vaginal childbirth and menopause. Vaginal childbirth stretches the vaginal wall and supporting tissues, while menopause reduces estrogen levels, which help maintain pelvic floor tissues.
Fortunately, there’s a variety of options to treat and prevent pelvic organ prolapse including lifestyle changes, pelvic floor exercises, a special device inserted into the vagina to help support the pelvic organs, and surgery.
It’s important to know that there is a subspecialty called urogynecology that was established in the 1990s to address pelvic floor disorders in women. Today this subspecialty is called female pelvic medicine and reconstructive surgery. These highly trained doctors are skilled and compassionate in talking to women about pelvic organ prolapse, and they can tailor an array of effective treatment options to your individual situation.
Why Choose Cooper to Diagnose and Treat Pelvic Organ Prolapse
Cooper University Health Care has a comprehensive urogynecology program that is on the forefront of care for pelvic organ prolapse in women. Our team of fellowship-trained urogynecologists offers a full range of today’s most advanced diagnostic and treatment services, delivered in a caring, sensitive manner:
- We have the region’s only pelvic floor physical therapy (PT) program, a specialized form of rehabilitation that focuses on strengthening the pelvic floor, which helps support the pelvic organs
- We have the region’s only robotic surgery program for treating pelvic floor disorders and pelvic organ prolapse—a minimally invasive approach that results in faster recovery, reduced pain and minimal scarring, in the event surgery is necessary
- We are involved in teaching the next generation of urogynecologists through a respected fellowship program—testament to the high level of clinical expertise available here
- Our urogynecologists are actively engaged in leading-edge research, giving you access to the latest knowledge and advances in treating pelvic organ prolapse in women
Causes and Risk Factors for Pelvic Organ Prolapse in Women
Pelvic organ prolapse occurs when the muscles or connective tissues (fascia) in the pelvic area weaken or loosen. The most common risk factors for developing POP include:
- Childbirth via vaginal delivery: This is the greatest risk for pelvic organ prolapse because delivering a baby vaginally can stretch and strain the pelvic floor muscles. The more vaginal deliveries you have, the greater the risk for pelvic organ prolapse later in life. Having larger babies (greater than 8 ½ lbs.) has also been shown to increase POP risk. But you can get prolapse even if you have never had children or if you had a cesarean (C-section) delivery.
- Genetics: POP runs in families. Our genes can affect the strength of our muscles and tissues, and some women are born at higher risk of prolapse due to having weaker tissues
- Menopause: The hormone estrogen helps women maintain muscle strength; the loss of estrogen during and after menopause raises the risk of POP
- Ethnicity/race: Caucasian women are at higher risk of POP than African American women
- Obesity: Studies show that obese women have a 40% to 75% increased risk of POP due to the long-term pressure of the weight on their abdomen
- Chronic coughing: This can result from smoking
- Chronic constipation: Chronic straining can weaken muscles and connective tissues
- Aging: Older women experience more POP than younger women; an estimated 50% of women over age 50 experience POP
- Repetitive heavy lifting: This can be job- or lifestyle-related (extreme weight-training, for example)
- Pelvic floor injury: This can result from falls, motor vehicle accidents, pelvic radiation, or surgery
- Hysterectomy: This procedure has been associated with development of POP
- Nerve and muscle diseases: These can include multiple sclerosis, Parkinson’s disease or stroke, which can contribute to the deterioration of pelvic floor muscle strength
Symptoms of Pelvic Organ Prolapse in Women
When POP occurs, it can cause a bulge in the vagina that you can feel or see. You may also feel pressure that makes physical or sexual activity uncomfortable. Other symptoms of pelvic organ prolapse include:
- A feeling of pressure, aching, or fullness in the pelvis
- Pelvic pressure that gets worse with standing or coughing, or as the day goes on
- Leaking urine (urinary incontinence) [LINK to UI page] or problems having a bowel movement
- Difficulty inserting tampons
In extreme cases, the prolapsed organ can begin to protrude out of the vagina.
Treatment for Pelvic Organ Prolapse in Women
Fortunately, there are several effective treatments for POP. Your specific treatment will depend on the type of prolapse you have, how severe your symptoms are, your age and general health, and whether you are sexually active.
Treatment may include one or more of these options:
- Pessary: This is a removable plastic or silicone device that you insert into the vagina to support the pelvic organs. It’s often the first treatment your doctor will recommend. Pessaries can help with POP and urinary incontinence.
- Dietary changes: If you have constipation, your doctor may recommend adding more fiber to your diet, which can help prevent constipation and straining during bowel movements. Drinking more fluids can also help.
- Pelvic floor muscle therapy: Your doctor may show you how to do targeted pelvic floor exercises or refer you to a specially trained physical therapist who will teach you how to strengthen your pelvic floor muscles
- Surgery: There are two main types of surgery for POP:
- Your doctor may use your own body tissue or synthetic mesh to repair the prolapsed organ and build a “sling” to support your pelvic floor. This type of surgery is recommended for sexually active women who have severe prolapse of the uterus or vagina.
- A procedure called colpocleisis treats POP by closing the vaginal opening. This is an effective option for women who no longer have vaginal intercourse.
There are several preventive steps you can take to reduce your risk of POP:
- Weight management: Maintain a healthy weight, or lose weight if you are overweight
- Avoid constipation: Eat a diet that includes the right amount of high-fiber foods and drink plenty of fluids
- Don’t smoke: In addition to all the other health risks that smoking poses, it can lead to chronic cough which puts stress on your pelvic floor muscles, raising your risk of POP