Pelvic organ prolapse (or “POP”) occurs when the muscles and connective tissues that support pelvic organs weaken causing descent of the organ (or organs) from their original positions into the pelvic cavity. The type of prolapse depends on where the weakness occurs and what organs are affected. Organs can prolapse independently of one another or simultaneously.
A cystocele is when the anterior wall of the pelvic floor muscles weaken and the bladder descends into the muscular wall. The bulge that is felt or seen in the vaginal canal is the bladder pressing on the muscular walls, not the organ itself.
A urethrocele is the descent of the urethra into the anterior wall of the pelvic floor, or bulges out of the urethral opening.
A rectocele is weakening of the posterior wall of the pelvic floor allowing the rectum to descend into the posterior pelvic canal. Again, the tissue felt or seen in the vaginal canal is the muscular walls of the pelvic floor, not the rectum itself.
A uterine prolapse is descent of the uterus and cervix into the pelvis.
A rectal prolapse is when the rectum bulges outside the anus. This type of prolapse can happen in males and females and in early stages can mimic hemorrhoids.
An enterocele is a prolapse of the small intestine which can fall into the posterior wall of the pelvis or the top of the vagina.
A vaginal prolapse (or vaginal vault prolapse) refers to the descent of the top of the vaginal (also called the vaginal vault) into the vaginal canal.
Symptoms of prolapse vary depending on the organ and location, but often include pelvic pressure or heaviness, feeling or seeing a bulge in the vagina, low back pain, pain with intercourse, urinary or bowel dysfunction including incontinence, urgency, frequency, or having to move or shift organs in order to evacuate stool or urine by inserting a finger into the vaginal canal and pressing forward or backward (also called “splinting”).
Causes of pelvic organ prolapse vary, but studies show weakening of the pelvic floor due to these factors increase risk of POP: history of vaginal delivery, long-term pressure in the pelvic cavity (chronic constipation contributing to straining, chronic cough, and lifting with poor mechanics), being overweight/obese, and aging (particularly following menopause when estrogen levels drop and connective tissue weakens). Exercise and heavy lifting has not been correlated to increased risk POP.
Conservative management of pelvic organ prolapse focuses on symptom reduction and management versus improving the grade of the prolapse. Findings from the large, multi-center randomized control trial Pelvic Organ Prolapse PhysiotherapY (POPPY) showed individualized pelvic floor muscle training significantly reduced symptoms in patients with grades I, II, and III POP. Patients who attend pelvic floor physical therapy are taught the correct coordination of the pelvic floor muscles and given an individualized home exercise program to target strength and endurance. Long-term benefits show patients who participated in the 16 week program had continued benefit at 6 and 12 month follow up.