Pelvic Organ Prolapse: Signs You Have It and How to Treat It

Yes, we know… you don’t want to talk about it. Describing what’s happening “down there” might be awkward and embarrassing. Maybe you’re reluctant to say the words pelvic organ prolapse. And we get it: Sharing that your bladder, uterus, or other pelvic organ has prolapsed, or dropped down from its normal position, and is now bulging into your vagina is not exactly small-talk material. 

But here’s one reassuring thing you should know: Studies show up to 50% of women will develop prolapse over their lifetime. That means some of the people you aren’t talking to about your condition are likely experiencing it as well. And here’s another important fact: Pelvic organ prolapse is very treatable. Read on to learn what can cause pelvic organ prolapse and how you can manage symptoms with pelvic floor physical therapy, exercise, diet and lifestyle changes, and other treatments.  

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse is a type of pelvic floor disorder. The pelvic floor is a group of muscles and tissues that stretches from your pubic bone in the front to your tailbone in the back. Like the foundation of a house, your pelvic floor helps support structures above it, such as your bladder and uterus, as well as your rectum and vagina. If these muscles become weak or damaged, the organs they support shift out of place. One or more pelvic organs can slip down and press into or bulge out of the vagina. There are several types of pelvic prolapse, depending on which organs are affected. You may have more than one type of prolapse. Your provider can evaluate the type(s) of prolapse you have with a pelvic exam:

• Cystocele is when your bladder drops down and presses into the anterior wall of the vagina, creating a bulge. This is the most common type of pelvic organ prolapse.

• Uterine prolapse is when the uterus drops down into the vaginal canal or out of the vaginal opening.

• Rectocele is when the rectum bulges into the back of the vaginal wall.

• Enterocele is when the small intestine bulges into the back wall or the top of the vagina. This type of prolapse is less common, but it can occur after a hysterectomy.

• Vaginal vault prolapse is when the top of the vagina (or vaginal vault) loses its support and drops into the vaginal canal or out of the vaginal opening. This type of prolapse is uncommon, but it can occur after a hysterectomy.

What Causes Pelvic Organ Prolapse?

Your pelvic floor can weaken for many reasons. When pelvic floor muscles and tissue do not work as they should, the organs they support are more likely to slip down from their normal position. Some risk factors for pelvic organ prolapse include:

• Vaginal delivery. This can stretch and strain the muscles and ligaments of the pelvic floor. Multiple childbirths, carrying twins or triplets, prolonged pushing, vacuum or forceps delivery, or giving birth to a larger-than-average baby can increase your risk of weak or injured pelvic floor muscles, which may lead to pelvic organ prolapse later in life. You can get prolapse, however, even if you have never had children or if you had a cesarean, or C-section, delivery.

• Aging and menopause. Pelvic floor disorders are more common in older women. Plus, decreasing estrogen levels during and after menopause may contribute to weakening connective tissue.

• Obesity. Studies have shown that overweight and obese women are more likely to have pelvic organ prolapse compared to those with a body mass index in the normal range.

• Long-term pressure on your abdomen. Chronic constipation, chronic coughing, and frequent heavy lifting can all overwork your pelvic floor muscles and increase your chance of prolapse.

Symptoms of Pelvic Organ Prolapse

The most common symptom is feeling or seeing a bulge in your vagina. Leaking urine (urinary incontinence) and fecal incontinence aren’t signs of prolapse, but they share some risk factors and sometimes occur along with it. Depending on your type of prolapse, other symptoms can include:

• The sensation that something is falling out of your vagina (like a tampon)

• Heaviness or aching in your pelvis

• Pressure or pain during sex

• Bulging or pressure that gets worse throughout the day, or when you cough, sneeze, or stand for too long

• Constipation and difficult bowel movements

• Feeling unable to empty your rectum

• Difficulty starting to pee or completely emptying your bladder

• Lower back pain

Physical Therapy for Pelvic Organ Prolapse

Weak pelvic floor muscles can contribute to organ prolapse. That’s why pelvic floor exercise and physical therapy is often the first line of treatment. 

You might know that Kegel exercises can help strengthen the pelvic floor muscles. And while they are very effective at treating prolapse, they are not the end-all, be-all. Many other exercises can help engage your pelvic floor muscles to better support your pelvic organs. A pelvic floor physical therapist (PT) can help determine the best exercises for you. You can see one in person or use a program like Hinge Health to access a PT via a telehealth video visit.

To ease symptoms and treat pelvic organ prolapse, your pelvic floor PT may recommend exercises including:

More Ways to Treat Pelvic Organ Prolapse

Depending on the severity of your prolapse and its impact on your quality of life, your healthcare provider may also suggest other treatment options as part of your plan. They could include:

• Vaginal pessary. This is a removable silicone device you insert in your vagina to help hold organs in place. Your doctor can fit you for a pessary or you can get one over the counter at a drugstore or online. Some people use a pessary all the time and some use them only during exercise or activities that worsen symptoms.

• Dietary changes. Eating more fiber-rich foods (such as whole grains, fruits and veggies, and beans) can help ease constipation, which is a risk factor for prolapse. If you are overweight or obese, your provider may recommend weight loss strategies to help improve symptoms.

• Surgery. If your symptoms have not improved with other treatments, you may be a candidate for surgery. Your healthcare provider will help determine if surgery is right for you. There are two main types of pelvic organ prolapse surgery:

  • Reconstructive surgery. This includes procedures targeted to repair the weakened parts of your pelvic floor and restore support to hold organs back in place.  

  • Obliterative surgery. Less common, obliterative procedures narrow or close off the vagina to provide support for organs that have dropped down.

PT Tip: The Way You Breathe Matters

“A key part of treating prolapse is managing abdominal pressure with proper breathing techniques,” says Dr. Daroski. “When you’re doing anything that increases pressure in your abdomen — like exercising, lifting something, or having a bowel movement — avoid holding your breath or straining. Instead, focus on breathing deeply and evenly to help reduce pressure on your pelvic organs.”

Learn More About Hinge Health for Pelvic Symptom Relief

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References:

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3. Carroll, L., O’ Sullivan, C., Doody, C., Perrotta, C., & Fullen, B. (2022). Pelvic organ prolapse: The lived experience. PLOS ONE, 17(11), e0276788. doi:10.1371/journal.pone.0276788

4. Giri, A., Hartmann, K. E., Hellwege, J. N., Velez Edwards, D. R., & Edwards, T. L. (2017). Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. American Journal of Obstetrics and Gynecology, 217(1), 11-26.e3.  doi:10.1016/j.ajog.2017.01.039

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6. Surgery for Pelvic Organ Prolapse. (2022, July). Www.acog.org. https://www.acog.org/womens-health/faqs/surgery-for-pelvic-organ-prolapse

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