TL;DR: Pelvic organ prolapse happens when the muscles and tissues supporting your pelvic organs weaken, letting the bladder, uterus, rectum, or top of the vagina drop down into or past the vaginal opening. Common signs include pelvic pressure or heaviness, a bulge you can see or feel, and bladder or bowel changes. Childbirth, menopause, aging, and chronic strain are the biggest causes. It’s very common and very treatable. Options range from pelvic floor exercises and a supportive device called a pessary to surgery for more advanced cases.
Feeling pressure or a bulge you can’t explain? Call Lona Sasser Obstetrics and Gynecology at 954-340-1050 or schedule online through ZocDoc for an evaluation.
What Is Pelvic Organ Prolapse?
Your pelvic organs, including the bladder, uterus, vagina, and rectum, are held in place by a hammock of muscles, ligaments, and connective tissue called the pelvic floor. When this support weakens or gets stretched, one or more organs can slip from their normal position and press into the vaginal walls. That’s pelvic organ prolapse.
It’s much more common than most people realize. Some degree of prolapse is found in many women who have given birth, and up to half of women may show some signs of it during a pelvic exam. Many never have symptoms. For others, it causes discomfort that affects daily life. Either way, it isn’t dangerous in most cases, and it’s nothing to be embarrassed about.
Types of Pelvic Organ Prolapse
Prolapse is named for the organ that has moved:
- Cystocele (anterior prolapse): The bladder drops into the front wall of the vagina. This is the most common type.
- Rectocele (posterior prolapse): The rectum bulges into the back wall of the vagina.
- Uterine prolapse: The uterus descends into the vaginal canal.
- Vaginal vault prolapse: The top of the vagina sags down, which can happen after a hysterectomy.
- Enterocele: The small intestine pushes against the upper back wall of the vagina.
It’s common to have more than one type at once. Providers also grade prolapse by severity, from mild (organs have dropped slightly) to advanced (tissue extends outside the vaginal opening).
Symptoms to Watch For
Mild prolapse often causes no symptoms at all. When symptoms appear, they tend to include:
- A feeling of heaviness, pressure, or fullness in the pelvis or vagina
- A sensation like something is falling out or like you’re sitting on a small ball
- A bulge of tissue you can see or feel at the vaginal opening
- Leaking urine with coughing, sneezing, or exercise
- Trouble fully emptying your bladder, or a weak urine stream
- Frequent urinary tract infections
- Constipation or needing to press on the vaginal wall to have a bowel movement
- Low back ache that eases when you lie down
- Discomfort or loss of sensation during sex
Symptoms are often milder in the morning and worse after standing, lifting, or a long day on your feet.
These symptoms are common, but they’re not something you have to live with. Our providers can examine you and talk through options that fit your life. Call 954-340-1050 or schedule online through ZocDoc.
What Causes Pelvic Organ Prolapse?
Pelvic organ prolapse usually results from a combination of factors that weaken the pelvic floor over time:
- Vaginal childbirth. This is the biggest risk factor, especially with multiple births, large babies, long pushing stages, or assisted deliveries.
- Menopause. Falling estrogen levels thin and weaken pelvic tissues. If you’re entering this stage, our guide to perimenopause explains what else to expect.
- Aging. Muscle and connective tissue naturally lose strength over time.
- Chronic pressure on the abdomen. Long-term constipation, a chronic cough, obesity, or heavy lifting all strain the pelvic floor.
- Prior pelvic surgery, including hysterectomy.
- Genetics. Some people are born with weaker connective tissue.
How Prolapse Is Diagnosed
Diagnosis usually starts with a conversation about your symptoms and a pelvic exam. Your provider may ask you to bear down or cough during the exam to see how far the organs move. Depending on your symptoms, you may also have a bladder function test, a urine test to rule out infection, or imaging such as a pelvic ultrasound. Prolapse is often first noticed during a routine well-woman exam, even before symptoms begin.
Treatment Options
Treatment depends on how severe the prolapse is, how much it bothers you, and your plans for the future, including whether you’d like more children.
Watchful Waiting
If prolapse is mild and doesn’t cause symptoms, no treatment may be needed. Your provider will keep an eye on it at regular visits.
Pelvic Floor Exercises and Physical Therapy
Kegel exercises strengthen the muscles that support your pelvic organs. Working with a pelvic floor physical therapist can make them much more effective, since many people do Kegels incorrectly on their own. This approach can ease symptoms and keep mild prolapse from getting worse.
Lifestyle Changes
Keeping a healthy weight, treating constipation, managing a chronic cough, and using good form when lifting all reduce strain on the pelvic floor.
Pessary
A pessary is a small, flexible silicone device placed in the vagina to hold organs in position. It’s a non-surgical option that works well for many people, and your provider will fit you for the right size and shape.
Vaginal Estrogen
For postmenopausal women, low-dose vaginal estrogen can help strengthen vaginal tissue and make a pessary more comfortable.
Surgery
When symptoms are severe or other treatments haven’t helped, surgery can repair weakened tissue and restore support. Options include procedures to repair the vaginal walls, suspend the vaginal vault, or, in some cases, remove the uterus. The Office on Women’s Health has a helpful overview if you’d like to read more about treatment choices.
Getting Support for Pelvic Floor Health
Pelvic organ prolapse is common, especially after childbirth and menopause, and many women quietly put up with symptoms for years. You don’t have to. Simple steps like pelvic floor therapy or a pessary can make a big difference, and surgery is an effective option when you need it. At Lona Sasser Obstetrics and Gynecology, we care for women in Coral Springs, FL, and nearby communities through every stage of life. Call 954-340-1050 or schedule online through ZocDoc to talk with a provider about your symptoms.
FAQ: Pelvic Organ Prolapse
Is pelvic organ prolapse dangerous?
Usually not. Prolapse is rarely life-threatening, but it can affect your comfort, bladder and bowel function, and quality of life. In rare advanced cases, it can block urine flow, so see your provider if you have trouble urinating.
Can pelvic organ prolapse heal on its own?
Prolapse doesn’t typically reverse on its own, but mild cases can improve with pelvic floor exercises and lifestyle changes. These steps can also keep it from getting worse.
Can I exercise with pelvic organ prolapse?
Yes. Most people can and should stay active. Walking, swimming, and pelvic floor strengthening are good choices. You may want to limit heavy lifting and high-impact activities, so ask your provider or a pelvic floor therapist for guidance.
Can I still have children if I have prolapse?
Yes. Many women with prolapse go on to have healthy pregnancies. If you’re planning more children, your provider may suggest a pessary or physical therapy rather than surgery until your family is complete.
How do I know if I have prolapse or something else?
Pelvic pressure and a vaginal bulge are classic signs, but other conditions can cause similar symptoms. A pelvic exam is the best way to know for sure.
Photo by Teona Swift