Pelvic organ prolapse (POP) is a common and often misunderstood disorder in which the rectum, bladder, uterus or vagina drop out of position because the pelvic floor muscles become weak or damaged.

This type of pelvic floor dysfunction can disrupt the performance of these organs and cause a wide range of symptoms, including discomfort. It’s important for women to recognize the signs of POP so they can see a doctor and get an accurate diagnosis. The sooner treatment begins, the sooner they can get relief and avoid further trouble and complications.

What is pelvic organ prolapse?

A network of muscles, ligaments, and other tissues form the pelvic floor, which acts like a basket to support the vagina, rectum, bladder, and uterus. The muscles, the main one being the levator ani, help to hold these organs in position. If the pelvic floor becomes weak, one or more of these organs may fall out of their usual locations, resulting in prolapse. In extreme circumstances, an internal organ may protrude from the body.

The most common causes of POP are:

• Childbirth and vaginal delivery can weaken pelvic floor muscles.
• Aging and post-menopausal changes reduce estrogen and weaken connective tissue.
• Genetic predisposition can lead to inherited weakness in pelvic floor tissues.
• Obesity and chronic physical strain (e.g., heavy lifting, chronic cough) increase abdominal pressure and strain the pelvic floor.
• Pelvic surgeries and hysterectomies may weaken pelvic floor support.
• Chronic constipation and straining during bowel movements can weaken pelvic muscles.
• Collagen irregularities, such as those found in connective tissue disorders like Ehlers-Danlos Syndrome, weaken pelvic floor tissues.

Types of pelvic organ prolapse

Each of the four main types of POP affects a different pelvic organ: the bladder, the rectum, the uterus, or the vaginal vault. For optimal symptom management and treatment adherence, it is essential to understand each type’s characteristics and distinctions.

Cystocele (bladder prolapse)

When the bladder droops into the anterior vaginal wall, it’s called a cystocele, or bladder prolapse. This is the most common type of pelvic organ prolapse. It makes it difficult to empty the bladder and causes feelings of pelvic fullness or pressure. Symptoms may include urinary incontinence, frequent urination, and discomfort.

Rectocele (rectal prolapse)

When the rectum sags into the posterior vaginal wall, or rear vaginal wall, it’s called a rectocele. When the rectum presses on the vaginal wall it can interfere with regular bowel movements. This may cause rectal discomfort, a feeling of incomplete evacuation (as though you have not fully emptied your bowel after a bowel movement), and other difficulties with bowel movements.

Uterine prolapse

In this type of POP, the uterus drops down into the vaginal canal. It can cause discomfort, bulging in the vagina, and pressure on the pelvis. In extreme instances, the uterus may even protrude beyond the vagina due to the weakening of the ligaments and muscles that support it, causing discomfort.

Enterocele

An enterocele occurs when part of the small intestine descends and pushes against the upper wall of the vagina, leading to symptoms such as a heavy pelvis and bulging vagina. This type of prolapse may occur along with other types of POP.

Symptoms of pelvic organ prolapse

Different types of POP affect different organs, they tend to share some common symptoms, such as:

• A feeling of pressure or fullness in the pelvic area
• Visible or palpable bulge in the vaginal area
• Urinary or bowel incontinence
• Difficulty with sexual activity
• Pelvic discomfort

Diagnosis of pelvic organ prolapse

The diagnosis of POP relies heavily on the expertise of a urogynecologist who specializes in diseases of the female pelvic floor. This specialist can determine whether a prolapse is affecting your rectum, bladder, uterus, or any other pelvic organ.

A comprehensive medical history and pelvic examination are the usual starting points for diagnosing POP. The doctor or nurse will ask you about symptoms like vaginal bulging, pressure, and incontinence while doing the examination.

To assess the severity of the prolapse, the medical specialist will perform a pelvic exam, often with the patient both standing and lying down. They will also assess the size of the genital hiatus (the opening at the bottom of the pelvic floor, through which the vagina and urethra pass) because an increase in size is associated with risk of a prolapse..

Treatment options for pelvic organ prolapse

The degree and type of pelvic organ prolapse determine the potential treatment choices. The primary goals of these therapies are symptom relief and an improvement in the quality of life.

Non-surgical treatments

• Pelvic floor exercises (Kegel exercises). Kegel exercises and other workouts for the pelvic floor help strengthen the muscles that support the organs and reduce the discomfort associated with prolapse.
• Pessary devices. Pessary devices are silicone implants that alleviate symptoms of prolapse by providing support and holding the prolapsed organs in place.
• Lifestyle modifications. Weight control, avoiding heavy lifting and constipation, and treating chronic cough can help to treat POP.

Surgical treatments

Women who feel uneasy about using a pessary device or have not experienced symptom relief from other measures may consider surgery. For more severe cases, especially those at high risk of recurrent prolapse and those requiring vaginal or abdominal repairs, different surgical approaches are available. Here are a few examples.

• Laparoscopic surgery. This is a minimally invasive procedure that involves making tiny incisions to gain access to the internal organs. Doctors may use a mesh to support the prolapsed structures or pull together the affected tissues so they can provide more support.
• This surgery involves removal of the uterus and may be used to treat a uterine prolapse.
• Vaginal prolapse repair

Long-term care and prevention

Seeing a urogynecologist for regular checkups allows for better monitoring of the genital hiatus and can help correct any problems that may arise. Ongoing pelvic health management is important for treating POP, maintaining bladder control, and preventing complications from childbirth trauma.

Valuable preventive measures that you can use to treat or help prevent POP include:

• Maintain proper posture and body mechanics to protect your pelvic health.
• Improve your core strength with pelvic physical therapy.
• Take breaks to avoid long periods of sitting or standing.
• Don’t smoke.
• Drink lots of water to ensure proper hydration (staying hydrated keeps your tissues strong). It’s also important to get enough dietary fiber and avoid constipation.
• Practice mindful bladder habits (e.g., avoid holding urine by emptying your bladder regularly).
• Keep your hormones balanced.
• Mindfulness and relaxation activities may decrease pelvic muscle tension and enhance pelvic health. Stress management also helps avoid persistent coughing and tension, which can worsen prolapse.

When to see a urogynecologist

If you’re experiencing symptoms like pelvic pressure or urinary difficulties and think you could be experiencing pelvic organ prolapse, don’t put off seeing a urogynecologist. At Florida Medical Clinic Orlando Health, we have a team of OB/GYN specialists who can assess your condition and provide you with personalized treatment plans. To get a proper diagnosis and a tailored treatment plan that takes into account your specific problem, it’s best to see a specialist.

About Dr. Mushonga

Dr. Nyarai Chinyani Mushonga uses her training and education to help patients improve their pelvic health. She specializes in a variety of pelvic floor disorders, including urinary incontinence, bowel control issues, and pelvic organ prolapse.

Following her graduation from medical school at Rutgers University, Dr. Mushonga completed a residency at Mount Sinai School of Medicine in reconstructive surgery and female pelvic care. She is a specialist in pelvic floor issues and uses her knowledge to create individualized treatment plans for her patients.

Request an appointment with Dr. Mushonga by calling (727) 553-7461.