Pelvic Organ Prolapse

What is Pelvic Organ Prolapse?
Pelvic organ prolapse (POP) occurs when the muscles and connective tissue in the pelvis weaken, resulting in prolapse or shifting of the pelvic organs from their normal position.  This weakening is most commonly a result of pregnancy, childbirth, advanced age, connective tissue disorder, obesity, pelvic surgery or repetitive straining and heavy lifting.  The organs in the pelvis that can be affected by POP include the rectum, uterus, cervix, vagina, urethra and bladder. 

What are the common symptoms of POP?

  • Feeling heaviness, fullness, pulling, or aching in the pelvis, vagina or rectum. It gets worse by the end of the day or during a bowel movement.
  • Seeing or feeling a "bulge" or "something coming out" of the vagina or rectum
  • Having a hard time starting to urinate or emptying the bladder completely
  • Leaking urine with coughing, laughing, or exercise
  • Feeling an urgency to urinate
  • Leaking stool or having a hard time controlling gas
  • Straining to have a bowel movement or feeling constipated
  • Feeling an urgency to have a bowel movement
  • Returning to the bathroom several times to finish having a bowel movement or repetitve wiping.
  • Using digital support or manipulation to assist in having a bowel movement

It is important to discuss these symptoms with your health care provider. 

What tests are available to help identify POP?
A thorough physical exam can help to identify the presence of POP.  Additional tests may also help to better determine the extent of POP and which organs are specifically involved. 

  • Cine Defecography:  One of the most useful tests to evaluate POP is defecography.  This is a fluoroscopic x-ray study that allows for visualization of the pelvic organs during defecation.  Shifting and prolapse of different organs can be seen during this special x-ray. 
  • Urodynamic Testing:  Urologists and urogynecologists may also perform urodynamic testing.  This testing focuses on both the ability to hold urine and the ability to empty the bladder. 
  • Additional tests:  Your healthcare provider may order one or more of the following tests: anorectal manometry, EMG recruitment, endoanal ultrasound, uterine ultrasound and colonoscopy.

How is pelvic floor organ prolapse (POP) treated?
Both non-surgical and surgical options are offered for treatment of POP.  The severity of prolapse and which organs are most affected by POP will determine which treatment option is best. 

Non-surgical treatment options for POP include

  • Pelvic Floor Exercises: A type of exercise to strengthen the pelvic floor by contracting and relaxing the muscles that surround the opening of the urethra, vagina, and rectum. The exercises are commonly referred to as Kegels.
  • Biofeedback Therapy:  A type of therapy that helps to retrain the pelvic floor muscles how to effectively squeeze and push.  This helps to improve feelings of urgency and/or evacuation of bowel movememts.
  • Pessary:  A removable device that is inserted into the vagina to support the pelvic organ(s) that have prolapsed.

Surgical treatment options for POP are aimed at improving the support of the pelvic organs and include

  • Sacrocolpopexy: Mesh is used to restore support to the vagina.
  • Rectopexy: Mesh or sutures are used to restore support to the rectum and improve symptoms of leakage or constipation caused by prolapse.
  • Bladder sling: Mesh is used to support the bladder and improve control and evacuation of urine.

The symptoms of POP can vary greatly amongst individuals and there are multiple surgical and non-surgical treatment options available. Due to the variety of treatment options, it is not possible to review each of these here. Consultation with a Pelvic Floor Specialist is helpful to determine the most appropriate evaluation and treatment for each individual patient.