Living with Pelvic Organ Prolapse: What is it and what options do I have?

Are my symptoms due to pelvic organ prolapse?

What is Pelvic Organ Prolapse (POP)? 

Ligaments, fascia, nerves and pelvic floor muscles help support the organs (bladder, uterus, rectum) in the pelvis.  When there is a disruption in these support tissues, through injury, misuse or genetic variables, the organs can bulge (prolapse) into the vaginal canal. Severity can vary, with some reporting little to no symptoms or significant enough for the organ to bulge out of the vagina. The severity of prolapse is graded or staged I - IV. 

Pelvic organ prolapse is an intimidating condition - affecting a woman’s physical and mental quality of life. With education and appropriate treatment we can feel more comfortable in our bodies and understand the steps to live an active life in spite of having a prolapse. 

How Common is POP and What are the Risk Factors?

Reports on the prevalence of this condition vary significantly, possibly due to underreporting.  Among women aged 50+, estimates suggest that 1 in 10 are affected. However, for women of childbearing age, the reported figures range from 32% to 64%.

Risk factors include: 

❇️Greater number of vaginal deliveries - with each birth the prevalence of POP increases by 10%-20%

❇️Persistent bearing down - with heavy activity, coughing, constipation. 

❇️Age - increased likelihood after menopause. 

❇️Overweight - potentially due to the strain it may place on supporting structures 

❇️Genetic tendency towards hypermobility

What does a POP feel like?

❇️Some women report a feeling of heaviness in the pelvis, a sensation of “sitting on a ball” or like a tampon that isn’t well inserted. 

❇️Changes in urinary or bowel function may occur - ranging anywhere from increased frequency, straining, to leakage. 

❇️Low back pain

❇️Sexual intercourse may be difficult or painful. 

All these symptoms have psychological impacts as well and may result in a decrease in self confidence and quality of life. 

What kind of treatments are available? 

There are a variety of treatment options ranging from conservative to invasive. Work with your health care professional to determine the right options for you based on the severity of the prolapse, your symptoms and goals. 

Physical therapy can work with you to properly engage your pelvic floor muscles to properly manage intra abdominal pressures during exercise, daily activities, have more efficient bowel movements and birth preparation. Your PT may use manual techniques to improve restrictions in fascia in the abdominopelvic region that may be impacting the efficiency of organ support. You will also receive guidance on proper body mechanics for daily activities along with suggestions for exercise intensity for your current level of fitness. Research supports physical therapy for POP stages I, II, III and show improvements in symptoms of heaviness, pain, bowel/bladder dysfunctions, however not in decreasing the stage, or severity, of POP. Some different approaches in physical therapy interventions focusing more on fascial components are showing better results in reversing the stage of prolapse. 

Pessaries - these are plastic or silicone devices inserted vaginally to support the organs throughout the day. They are fitted to you by a professional with your anatomy and lifestyle goals in mind. They are left in for a period of time, then removed, cleansed and re-inserted. This may be done by a medical professional or in some cases by the woman herself. 

Surgery is typically reserved for more severe prolapses and used to surgically support the organ that has descended. There are various options for surgical repair which should be discussed with your doctor. More studies are needed to better support if physical therapy can make a significant difference in the long term results of surgery. Some studies show a failure rate of 31%-40%

Since physical therapy offers a viable and harmless option for addressing modifiable risk factors it could be a consideration pre and post surgery.  

If you’re experiencing symptoms of pelvic organ prolapse, or even just suspect something feels “off,” you’re not alone, and you don’t have to navigate it in silence. Whether you’re seeking relief, prevention, or guidance before or after surgery, scheduling an appointment is a powerful first step toward reclaiming control. Let’s help you feel at home in your body again.

REFERENCES:

Crowle, Anna PT1; Harley, Clare PhD2. Biotensegrity Focused Therapy for Pelvic Organ Prolapse: A Nonrandomized Prospective Clinical Case Series. Journal of Women's Health Physical Therapy 45(3):p 135-142, July/September 2021. | DOI: 10.1097/JWH.0000000000000210 

Panman CMCR, Wiegersma M, Kollen BJ, Berger MY, Lisman-Van Leeuwen Y, Vermeulen KM, Dekker JH. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care. BJOG 2017; 124: 511–520.

Hadizadeh-Talasaz Z, Khadivzadeh T, Mohajeri T, Sadeghi M. Worldwide Prevalence of Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis. Iran J Public Health. 2024 Mar;53(3):524-538. doi: 10.18502/ijph.v53i3.15134. PMID: 38919293; PMCID: PMC11194659.

https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-organ-prolapse/