What is Pelvic Organ Prolapse?
A urogynecologist explains the causes and symptoms and how to help prevent this common condition.
While issues in the pelvic area are not something that many women may feel comfortable discussing openly, they are a lot more common than people may assume. Up to 50% of women will develop pelvic organ prolapse in their lifetime, when one or more pelvic organs, such as the uterus or bladder, drop from their normal position. This is caused by weakened pelvic floor muscles and tissues that support and hold the pelvic organs in place. When pelvic organ prolapse occurs, women may feel symptoms such as pressure or pain in the lower stomach, back, and vagina; urinary changes; and constipation.
“Women would be surprised at how many people are suffering from prolapse, even people in their own lives,” says Dr. Larissa V. Rodríguez, urologist-in-chief and director of the Center for Female Pelvic Health at NewYork-Presbyterian and Weill Cornell Medicine. “There’s remarkably little conversation about it between friends or family members, so women often feel that ‘it’s only happening to me’ and there’s nothing they can do about it.”
Though mild prolapse may not need treatment, for those with bothersome symptoms, “prolapse is a very treatable condition,” Dr. Rodríguez says. If you have prolapse, she recommends seeing a urogynecologist, an expert in pelvic floor health. “I want them to know that they don’t have to suffer in silence,” she says.
Dr. Rodríguez spoke with Health Matters to share what to know about prolapse, including how it develops, ways to reduce your risk, and treatment options.
Risk factors of prolapse include childbirth and age.
The biggest cause of pelvic organ prolapse is vaginal birth. “After deliveries, there are ligaments that elongate for some women and some muscles in the pelvic floor may actually rupture, even if the woman doesn’t have symptoms,” Dr. Rodríguez explains. “Those patients tend to develop prolapse further down the line.”
Childbirth aided by forceps, vacuum devices, or episiotomy — a cut a doctor makes to enlarge the vaginal opening — increases the risk of prolapse. The baby’s size can also make a difference.
Other risk factors include frequent heavy lifting, obesity, smoking, chronic coughing, and ongoing constipation and straining, which put pressure on the pelvic area. Prolapse also runs in families with some people having a genetic predisposition for it, Dr. Rodríguez says. Aging is also a factor because muscles atrophy with age, compounded by declining estrogen that occurs during menopause. Among those with prolapse, 6% of women under age 30 feel symptoms, rising to about 30% at age 50, and almost 50% at age 80 and older, according to Dr. Rodríguez. Symptoms include pressure in the vagina, lower back pain, the feeling of sitting on a small ball. In some cases, pelvic organs will protrude outside the vagina.
Types of Organ Prolapse
Bladder Prolapse
Symptoms: Patients can have frequent or urgent urination. If it’s advanced, they may have difficulty urinating and may retain urine, which can lead to urinary tract infections.
Uterine Prolapse
Symptoms: In addition to urinary and bowel problems, people feel pressure in the pelvis, and when particularly advanced, the prolapsed uterus can block the kidneys.
Rectum Prolapse
Symptoms: People may have difficulties emptying the bowels and bladder because the rectum is not aligned.
Symptoms may develop gradually, but can also happen suddenly.
Prolapse tends to happen gradually, Dr. Rodríguez says. “But the patient might experience it all of a sudden, because when it’s mild people might not even be aware they have it,” she says. “It’s not unusual for patients to say, ‘I was coughing really hard, and all of a sudden I felt something.’ The truth is that they probably had some level of descent, but something pushed the organ to fall further, so that they went from no symptoms to a lot of symptoms.”
Prolapse is treatable.
Pelvic floor physical therapy, which includes exercises to strengthen the pelvic floor, can help improve symptoms from mild or even moderate prolapse, says Dr. Rodríguez.
A pessary, a device that’s inserted into the vagina to hold the prolapsed structures in place, can also be an effective non-surgical option that helps provide support.
Minimally invasive surgery, including robotic procedures, that repair the affected area and secure organs into their proper place may be needed if prolapse is interfering with a patient’s health or quality of life. “The outcomes for surgery are very good,” says Dr. Rodríguez.
You can reduce your risk for prolapse.
Lifestyle changes like avoiding heavy lifting, not smoking, managing chronic coughing and constipation, and maintaining a healthy weight all help prevent prolapse. Although it’s impossible to predict complications that might arise during a baby’s delivery, you can ask your doctor to try to avoid forceps, vacuums, and particularly episiotomy, if possible. Starting Kegel exercises during pregnancy or after childbirth can help strengthen pelvic floor muscles, Dr. Rodríguez says. “Most people need to be shown how to do them correctly, without contracting the rectum or the abdomen,” she says. Your gynecologist can let you know if you are contracting the right muscles and provide general guidance.