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Pelvic organ prolapse is a condition that many women may not hear about until they experience symptoms or receive a diagnosis during a routine pelvic exam–and men during a routine physical exam. While it only affects a small percentage of men and women, it’s important to understand what it is, what causes it, and how it can be treated—especially as we age or after childbirth.
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when one or more organs in the pelvis—such as the bladder, rectum, uterus, or the top of the vagina—shift downward and press against the vaginal walls. This descent happens when the muscles and tissues that normally support these organs become weakened or damaged.
The condition can affect:
- The anterior vaginal wall (front),
- The posterior vaginal wall (back),
- The uterus or cervix, or
- The vaginal apex (top part, especially after a hysterectomy).
Although most cases are mild and managed without surgery, a small percentage of women may need surgical treatment.
What are the Common Symptoms of Pelvic Organ Prolapse?
Common signs and symptoms include:
- A feeling of vaginal or rectal bulging or pressure
- Pelvic or rectal discomfort
- Low back pain
- Unusual vaginal or rectal discharge, bleeding, or recurrent infections
- The need to press on the vaginal wall to assist with bowel movements (called splinting or digitation)
- Symptoms that worsen with straining or standing and improve when lying down or elevating the legs.
Who Is at Risk?
Pelvic organ prolapse is more common in older women, especially those who are post-menopausal. However, several other factors may contribute to the development of this condition, including:
- Connective tissue disorders (e.g., Ehlers-Danlos syndrome, Marfan syndrome)
- Muscle, ligament, or nerve damage, often from childbirth
- History of pelvic surgery, like hysterectomy
- Chronic straining, due to constipation, chronic cough, or heavy lifting
- Menopause, due to reduced estrogen and weakened tissue
- Race, with Caucasian women having a higher risk
Additionally, pelvic organ prolapse may be linked to underactive, overactive, or non-functioning pelvic floor muscles.
What are the Types of Pelvic Organ Prolapse?
Prolapse can involve different areas of the pelvic floor and is usually described by the organ involved and its position:
1. Posterior Wall Prolapse (Rectocele)
This occurs when the rectum pushes against the weakened back wall of the vagina, causing a bulge.
Symptoms may include:
- A sense of vaginal pressure
- A visible or palpable bulge
- Difficulty with bowel movements
- Needing to reposition or press on the vaginal wall to fully empty the rectum
2. Anterior Wall Prolapse (Cystocele or Bladder Prolapse)
This happens when the bladder drops into the front wall of the vagina, sometimes along with the urethra.
Symptoms may include:
- A weak or slow urine stream
- Incomplete emptying of the bladder
- Needing to change positions to urinate
- Stress incontinence (leaking with coughing, laughing, etc.)
- Dribbling after urination
3. Enterocele (Small Bowel Prolapse)
Often seen in women who’ve had a hysterectomy, this occurs when the small intestine presses into the vaginal wall due to upper vaginal support weakening.
Symptoms may include:
- Pelvic pressure or fullness
- Difficulty emptying the bowel or bladder
- Lower back pain that worsens throughout the day
- Relief when lying down
4. Uterine Prolapse
This results from weakening of the ligaments supporting the uterus, allowing it to descend into the vaginal canal. It is graded in four stages:
- Stage 1: Uterus droops into the upper vagina
- Stage 2: Uterus reaches the lower vagina
- Stage 3: Cervix protrudes at the vaginal opening
- Stage 4: Entire uterus is outside the vaginal opening (complete prolapse)
Symptoms may include:
- Blood-stained or pus-like vaginal discharge
- Urinary or bowel difficulties
- Low back pain, worse at the end of the day
- Increased discomfort with prolonged standing
5. Vaginal Vault Prolapse
This condition occurs after a hysterectomy, when the top of the vagina (no longer supported by the uterus) begins to fall. It may turn inside out and often co-exists with an enterocele.
Symptoms may include:
- Sensation of heaviness or bulging
- Difficulty with bowel or bladder emptying
How Is Pelvic Organ Prolapse Evaluated?
A full assessment typically includes:
- Detailed medical history
- Physical and pelvic examination
- Assessment of pelvic floor muscle function
- Possibly advanced imaging (MRI, defecography) or urodynamic testing, depending on symptoms
- General musculoskeletal screening (hips, spine, flexibility)
Treatment Options
1. Pelvic Floor Therapy
Most cases of prolapse can be managed without surgery. Treatment may involve:
- Manual therapy and targeted exercises to strengthen or relax pelvic floor muscles
- Biofeedback, to help you learn which muscles to engage
- Bladder retraining, to manage urgency or leakage
- Electrical stimulation, to help relieve pain or activate muscles
2. Pessary Use
A pessary is a small, silicone device inserted into the vagina to support the pelvic organs. It's non-surgical and often recommended for women who aren’t ready for or cannot have surgery.
Benefits include:
- Improved vaginal bulge symptoms
- Reduced bladder pressure or irritation
- Improved self-image
Possible side effects:
Vaginal discharge, mild bleeding, pain, constipation, or odor (serious issues are rare).
3. Surgery
In more severe cases, especially when quality of life is significantly impacted, surgery may be considered. The specific surgical approach depends on the type and severity of the prolapse, the patient’s health, and personal preferences.
Final Thoughts
Pelvic organ prolapse is a manageable condition, especially when detected early. While it can feel uncomfortable or even alarming, there are several effective treatment options—many of which don’t involve surgery. If you’re experiencing symptoms, speak with a gynecologist or pelvic floor specialist for a proper diagnosis and personalized care plan.
Need support or guidance on pelvic floor health? If you’re experiencing pelvic floor dysfunctions associated with the issues above, please reach out to us at Activcore Physical Therapy to set up an evaluation and treatment!
Works Cited:
https://www.emedicinehealth.com
Disclaimer: The views expressed in this post are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
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