Get the facts about pelvic organ prolapse

Pelvic organ prolapse (POP) is a weakening of the support structures that hold a woman's pelvic organs (bladder, uterus, top of the vagina and rectum) in place. If your muscles and connective tissue become weak, stretched or torn, your pelvic organs can bulge into your vagina. In severe cases, this bulge can extend into and beyond your vaginal opening so you can see and feel it.

Pelvic organ prolapse can be a real downer, impacting your ability to be physically and sexually active, socialize and feel comfortable. The good news is, if you have symptoms of pelvic organ prolapse you don’t have to wait until things are really bad to seek help. Treatment options for prolapse are available.

What are the symptoms of pelvic organ prolapse?

Prolapse often begins with a sense of fullness or heaviness in your vaginal or pelvic area. It can feel like something is falling down or out of your vagina (like a tampon falling out) or feel like you’re sitting on something. You also might have urinary symptoms. Some women even need to use their fingers to press inside their vagina to be able to empty their bladder or have a bowel movement.

How does pelvic organ prolapse happen?

Pelvic organ prolapse can happen slowly, over time and it does tend to run in families. Pregnancy, including vaginal deliveries and episiotomies, can damage your pelvic floor, which puts you at risk for pelvic organ prolapse. Smoking, repetitive straining from constipation, coughing, extremely heavy lifting and obesity also can worsen the condition. Pelvic organ prolapse also is more common after menopause and if you’ve already had a hysterectomy or other surgery for a prolapse.

How do I prevent pelvic organ prolapse from happening or getting worse?

Pelvic floor exercises (Kegels) can be helpful to prevent pelvic floor disorders including urinary leaking and pelvic organ prolapse. While Kegel exercises do not fix a prolapse, they can help improve your symptoms and prevent a vaginal bulge from getting worse. Maintaining a healthy weight, preventing constipation or a chronic cough, and quitting smoking are all lifestyle changes that can help you prevent pelvic organ prolapse.

How is prolapse diagnosed?

A doctor can determine if you have prolapse and its severity through a physical with a pelvic exam. There are different types of prolapse, based on the pelvic organ or organs involved. Often, several organs may be contributing to your symptoms. The most common include the front wall/bladder, top of the vagina/uterus, and back wall/rectum.

What are treatment options for prolapse?

Based on your examination, a urogynecologist (a doctor who specializes in pelvic floor problems in women) will discuss treatment options with you. Your goals for treatment can help determine the best options for you.

Common pelvic organ prolapse treatment options include:

• pelvic floor physical therapy
• a pessary (a device worn in the vagina that holds up your prolapse)
• surgical correction:

• native tissue repair with or without hysterectomy
• vaginal repair using your own tissue to repair the bulge (native tissue repair)
• a mesh abdominal graft called sacrocolpopexy. (This is not transvaginal mesh which was removed from the market in early 2019).

Read more about the types of surgery for pelvic organ prolapse here:

Read more about mesh in urogynecology here: