The Low-Down on Pelvic Organ Prolapse

Written by Dr. Susan Miller PT, DPT, and originally posted on www.lotuscorept.com 

Have you ever felt pressure or seen a bulge around the vaginal opening? Did you just have a baby and are feeling heavy pressure? Do you feel like you are not emptying when you void or when passing a bowel movement? 

What you might be experiencing is Pelvic Organ Prolapse. 

What is pelvic organ prolapse? 

Pelvic organ prolapse (POP) is a descent of the vaginal organs that creates a bulge or pressure into the vaginal opening. This occurs due to a weakening of the support structures that hold these organs in place such as the ligaments, health of the vaginal tissue and pelvic floor muscles. The most common types of prolapse are:

• Bladder (Cystocele)/Urethra (Cystourethrocele)

• Rectum (Rectocele)

• Uterus (Uterine)

In some cases, the small bowel (Entrocele) can protrude towards the vaginal canal and if you have had a hysterectomy, the vaginal cuff (vaginal vault) can move downward. 

There are 4 stages of pelvic organ prolapse as seen in the image to the left with Uterine Prolapse.  

Stage I: Pelvic organs has started to drop slightly into the vaginal canal

Stage II: Pelvic organs have dropped towards the vaginal opening 

Stage III: Pelvic organs have dropped to the opening of the vaginal canal and beyond

Stage IV: Pelvic organs have dropped outside of the vaginal canal 

Symptoms of Pelvic Organ Prolapse: 

• Heaviness or dragging feeling

• Urinary Incontinence 

• Urinary Frequency 

• Pressure in the vaginal opening or lower abdominals 

• Stools feeling stuck 

• Pain with intercourse

• Seeing or feeling a bulge 

Pelvic organ prolapse is dynamic and can change throughout the day based on activity and gravity.  Many individuals will seek treatment when symptoms start to be symptomatic or they are feeling a bulge at the opening of the vaginal canal. Prolapse typically doesn’t happen overnight or because you lifted that heavy object. The descent has been slowly occurring and most likely was asymptomatic.  Prevention is key!

Common Risk Factors of Pelvic Organ Prolapse: 

• Constipation and/or holding your breath during bowel movements 

• Lifting techniques or jobs that require heavy lifting

• Repetitive breath holding with activity

• 3rd or 4th degree lacerations during delivery 

• Forceps or vacuum assisted deliveries 

• Higher BMI 

• Hypermobility conditions such as EDS 

• Multiple vaginal births 

• History of hysterectomy

• Genetics

Treatment of Pelvic Organ Prolapse: 

As seen above, POP can contribute to many pelvic floor symptoms but can also bring on a variety of emotions. There is treatment provided that is offered conservatively and helps you build confidence when living with prolapse.  

Pelvic Floor Physical Therapy (PFPT): Conservatively, start with seeing a pelvic floor physical therapist. Physical Therapists are experts in the musculoskeletal system and will provide strategies on how to manage the above symptoms. An important treatment for prolapse is pelvic floor muscle strengthening but this isn’t the only thing physical therapy can offer. A holistic approach involving functional strength, posture, pressure management and body mechanics are factors that should be addressed when diagnosed or if prolapse is suspected. Unfortunately when diagnosed with a specific stage, physical therapists are not able to change the stage per se, PT’s can improve on the symptoms that may be rooted from the prolapse. PFPT is to help you gain confidence on moving throughout the day and with exercise. 

Pessary: Another Conservative option is wearing a Pessary.  A pessary is a device inserted into the vaginal opening to prevent the organs from descending downward. This device is inserted into the vaginal canal to provide support to the descend organs. You can think of a pessary similar to a sports bra. A pessary is fitted by a Uryogynecologist, OBGYN, Physicians Assistant, Nurse Practitioner or in some regions, a Physical Therapist.  A pessary can be worn all day or just with certain activities like the workout class that you like to attend.  Many individuals have successfully managed their symptoms with this option and in conjunction with PFPT.  

Urogynecology: Establishing a relationship with a board certified Urogynecologist. Urogynecologists are specialists in managing prolapse and other pelvic floor conditions, they can officially diagnose the stage along with rule in and out other contributing factors to your symptoms. While surgery may be an option, oftentimes they refer to pelvic floor physical therapy to start managing conservatively or help you get ready for surgery. 

If you have experienced one of the symptoms or have seen a bulge, schedule your appointment with Susan Miller, PT, DPT, at Lotus Core PT to help address any concerns or questions.

All Images used with permission from Pelvic Guru®, LLC www.pelvicglobal.com