Pelvic organ prolapse (POP) is a common condition that affects many women, especially after childbirth or during menopause. Often underdiagnosed or mistaken for other issues, recognizing the symptoms of POP—such as pelvic pressure, urinary problems, or a bulge near the vaginal opening—can make a significant difference in receiving the right treatment. Understanding the different types of POP and knowing when to see a healthcare provider are essential first steps in managing this condition.
In this Q&A, Leah Nakamura, MD, a Urologist and Pelvic Health Program Physician Advisor at Hoag, explains how POP is diagnosed, why it’s important to treat, and outlines a range of treatment options—from pelvic floor therapy to surgery. This guide offers valuable insights to help you understand your options and take the next step toward relief and recovery.
What is Pelvic Organ Prolapse?
Pelvic organ prolapse happens when the muscles and tissues that support the pelvic organs – like the bladder, uterus, rectum, or vaginal wall – become weak or stretched. As a result, one or more of these organs drop – or prolapse – into the vagina.
What causes POP?
The most common causes include vaginal childbirth, especially multiple or complicated deliveries, aging, menopause (due to lower estrogen levels), chronic constipation, obesity and heavy lifting. Certain types of connective tissue disorders can also put patients at increased risk of prolapse. Anything that puts long-term pressure on the pelvic floor can contribute.
What are the Types of POP?
There are several types, depending on the organ affected:
- Cystocele: when the bladder bulges into the vagina
- Rectocele: when the rectum bulges into the vagina
- Uterine prolapse: when the uterus descends into the vaginal canal
- Enterocele: when the small intestine or other intrabdominal organs push into the vagina
- Vaginal vault prolapse: usually occurs after a hysterectomy, when the vaginal wall everts out towards the vaginal opening
What are the Symptoms?
Common symptoms include a feeling of pressure or fullness in the pelvis; seeing or feeling a bulge at the vaginal opening; urinary leakage or difficulty emptying the bladder; constipation; and discomfort during sexual intercourse. Some women also report lower back pain or a sensation of something “falling out.”
When Should Someone See a Healthcare Provider?
If someone notices a bulge, experiences pelvic pressure, or has changes in urinary or bowel habits, it’s a good idea to see a provider. Early evaluation can prevent symptoms from worsening and help identify the best treatment options.
How is the Condition Diagnosed?
A pelvic exam is usually all that’s needed to diagnose pelvic organ prolapse. In some cases, the provider may ask the patient to bear down (as if during a bowel movement) to better assess the degree of prolapse. Additional imaging like an ultrasound or MRI is rarely needed but may be used in complex cases.
Why is it Important to Treat?
Left untreated, prolapse can worsen over time and significantly affect quality of life. It can cause discomfort, urinary or bowel dysfunction, and sexual problems. Treating pelvic organ prolapse early can relieve symptoms and prevent complications.
What Treatments are Available?
Treatment depends on the severity and the patient’s symptoms and goals. Options include:
- pelvic floor physical therapy;
- pessary devices inserted into the vagina for support;
- lifestyle changes, like weight loss or avoiding heavy lifting; and
- surgery to repair or support the prolapsed organs.
Any Other Insights?
Pelvic organ prolapse is common, especially as women age, but it’s not something that should be accepted as “normal.” It’s very treatable, and many women feel significantly better once they get the right care. Having an open conversation with a provider is the first step.
Learn more about pelvic relaxation and pelvic organ prolapse here, and find an overview of Hoag’s gynecologic and pelvic health program here.
