Pelvic Organ Prolapse: What Women Should Know

What is pelvic organ prolapse?
Prolapse is defined as a slipping forward or down. Pelvic organ prolapse occurs when a pelvic organ drops from its original position in the pelvis and puts pressure on the vaginal wall. Organs that can be involved are the bladder (cystocele), urethra, rectum (rectocele), uterus, vagina, or small bowel (enterocele). Prolapse can be limited to a single organ or involve multiple organs.

Pelvic organ prolapse is experienced primarily by women. It is most common in women over 50 years of age and in Caucasian and Hispanic women greater than African American women.

What causes pelvic organ prolapse?
Pelvic organ prolapse occurs when the muscles and connective tissue that support the pelvic organs are weak or overstretched. Pelvic organ prolapse is most often associated with pregnancy and childbirth. A woman is 8 times more likely to experience prolapse after two vaginal births and 12 times more likely after 4 vaginal births. The strain on the muscles and connective tissue during childbirth stretches the tissue out and if they do not recover they can no longer support the pelvic organs. Hysterectomy, which is a surgery to remove the uterus, can also be associated with the prolapse of other pelvic organs because it leaves the other organs with less support.

Other risk factors for developing or worsening pelvic organ prolapse include obesity, chronic constipation or straining with bowel movements, a long lasting cough, smoking, pelvic tumors, pelvic surgery, neurological disorders, age, menopause, and family history.

What are the symptoms of pelvic organ prolapse?
Some common symptoms of pelvic organ prolapse are a feeling of pressure on the vaginal wall, feeling like something is falling out of your vagina, dyspareunia or pain with intercourse, incontinence or the leakage of urine, bowel changes such as constipation, lower back pain, and a feeling of fullness in the lower abdomen. In severe cases tissue may be seen protruding from the vaginal opening.

How is pelvic organ prolapse diagnosed?
Pelvic organ prolapsed is diagnosed by a physician based on medical history and physical examination including a vaginal exam. Other testing including various imaging and urodynamic testing may be recommended to determine the exact nature of the prolapse.

How is pelvic organ prolapse treated?
There are many different treatment options available. Where treatment begins is based on which organs are prolapsed and how severe the symptoms are. In mild cases, treatment may be limited to lifestyle changes and exercises (Kegels) to strengthen the pelvic floor musculature. Physical therapy or biofeedback therapy may be recommended by the physician. In more significant cases a physician may recommend a pessary, which is a device that is inserted in the vagina to help support the pelvic organs.  In severe cases, surgery may be recommended.

How can physical therapy help?
Physical therapy can be instrumental in the relief of symptoms from pelvic organ prolapse. A physical therapist that specializes in the treatment of pelvic floor dysfunction can educate patients on lifestyle changes that can decrease symptoms, teach proper performance of Kegel exercises, perform biofeedback for the pelvic floor musculature to re-educate and strengthen the muscle of the pelvic floor to help support the prolapsed organ, teach proper posture and body mechanics with lifting and other ADLs and functional activities to reduce the strain on the pelvic organs, and identify other strength deficits of the lumbopelvic region and lower extremities that may be contributing. These interventions can help to reduce the pain/physical discomfort with daily activities, decrease incontinence and bowel changes, and improve pain with intercourse.