Pelvic Organ Prolapse: Causes, Symptoms, Treatments

Pelvic organ prolapse is a condition common in women that leads to urinary retention, urinary incontinence, problems with bowel movements, and pain and discomfort in the pelvic region. It happens more commonly in older women, women who have given multiple vaginal childbirths, and women who are Caucasian or Hispanic. Although women who don’t fit these criteria, and men, can also get pelvic organ prolapse. 

This article will discuss the condition’s causes, symptoms, and treatments, as well as the different types and stages of pelvic organ prolapse. 

What is pelvic organ prolapse? 

The pelvic organs are internal organs in the pelvic area such as the bladder, the small bowel, and the rectum. For women, pelvic organs also include the uterus, vagina, and cervix. 

Prolapse refers to when something has slipped or dropped from its original place. 

Under normal circumstances, the pelvic floor— a group and muscles and tissues—holds and pelvic organs up like a hammock and keep everything in place. When the pelvic floor weakens, the rectum, bladder, and uterus can drop down and press into surrounding tissues and organs. This is called pelvic organ prolapse, a condition common in women but can occur in men as well.

Pelvic organ prolapse can lead to urinary retention, urinary incontinence, and fecal incontinence. In severe cases, the rectum can protrude out of the anus, and the uterus can protrude out of the vagina. 

For people with urinary retention, a condition that prevents the bladder from draining urine completely, intermittent catheters are often prescribed to help them drain the bladder 5-6 times a day.  

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What causes pelvic organ prolapse?

The main cause of pelvic organ prolapse is the weakening or damage of the pelvic floor. A range of factors can stress the pelvic floor and weakens it, and the most common ones are:

• Pregnancy
• Childbirth
• Obesity
• Aging
• Menopause
• Chronic coughing
• Chronic constipation

What most of these causes have in common is, they put pressure and stress on your pelvic floor. Childbirth, pregnancy, chronic coughing, chronic constipation, and obesity all put pressure on your pelvic floor. 

The pelvic floor also weakens with age, and older women have higher instances of POP than younger women. The decrease of estrogen production during menopause can also lead to pelvic organ prolapse. 

Types of pelvic organ prolapse

Bladder prolapse, also known as anterior prolapse or cystocele, is the dropping of the bladder, which can lead to urinary retention and stress incontinence. When the bladder drops, it can press into the vagina. 

Uterine prolapse is the prolapse of the uterus. It can lead to symptoms of urinary retention, incontinence, difficult bowel movements, and tissue protruding from the vagina. 

Rectal prolapse is the prolapse of the rectum, the last part of the big intestine leading to the anus. This condition leads to difficulty controlling bowel movements, constipation, and rectal bleeding. The rectum can protrude out of the anus, and ulcers can develop on the protruding parts. 

What are the symptoms of pelvic organ prolapse? 

These are some of the common symptoms of POP, some symptoms may vary depending on the specific type of POP. 

• Fulness, heaviness, and pain in the pelvis, particularly in the vagina
• Feeling like something is falling out of the vagina
• A bulge in the vagina
• Tissues protruding from the vagina
• Urinary retention: inability to start urination and void fully; frequent urination with little volume
• Urinary incontinence: involuntary leakage of urine
• Difficulty starting bowel movements
• Fecal incontinence  

If you have any of these symptoms or suspect you have POP, please reach out to your doctor for a formal diagnosis. 

Pelvic organ prolapse stages 

There are four stages of POP: 

1. Very mild prolapse, pelvic organs are mostly in place and fairly well supported 
2. Pelvic organs have begun to fall, but are still contained within the vagina/rectum 
3. Pelvic organs have reached the opening of vagina/anus
4. Pelvic organs have completely fallen out of the opening of the vagina/anus. 

Pelvic organ prolapse treatment (non-surgery)

Here are some of the treatments your doctor may recommend first if your condition is relatively mild. 

• Kegels: exercises you can do to strengthen your pelvic floor muscles.
• Biofeedback therapy: a kind of physical therapy that places monitor devices into your vagina, rectum, and on your skin to track muscle movements so you can practice how to control them. 
• Medication: if your POP is due to the decrease of estrogen level in menopause, estrogen may be prescribed to you.
• Pessary: a soft device that is placed inside the vagina to give support to the pelvic organs. 

Pelvic organ prolapse surgery 

If the above non-surgical treatments would not work, surgery may be needed. There’re two types of pelvic organ prolapse surgery:

1. Reconstructive surgery puts the pelvic organs back to their original position. 
2. Obliterative surgery narrows or closes off part of the vagina to give more support to the pelvic floor organs. This surgery will take away your ability to have vaginal intercourse, so it’s performed when reconstructive surgery hasn’t worked and/or when your body cannot tolerate another major procedure. 

Please note that this article does not serve as formal medical advice and should not be used to self-diagnose or self-treat. Please consult a medical professional for the diagnosis and treatment of your condition. 

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