As we’ve covered in previous posts, the pelvic floor is a complex system of muscles with two major functions: supporting the vagina and pelvic organs, and maintaining urinary and bowel continence.
But when those muscles are damaged (especially after childbirth), bladder, rectal, or uterine tissue may begin to bulge into the vagina. In serious cases, women may see or feel these tissues protruding through the opening of their vagina. This is known as pelvic organ prolapse (POP), and it’s more common than you think, with researchers estimating that one in three women will undergo surgery for some type of pelvic floor disorder in their lifetime.
Likelihood of developing POP increases after giving birth, and many other things can exacerbate it. Menopause, previous pelvic floor surgery, previous hysterectomy, connective tissue or nerve disorder, or obesity can all cause prolapse. A traditional pelvic exam is the best way to evaluate and diagnose POP. If any of these risk factors apply to you or someone you know, it’s important to recognize the symptoms that may point to POP:
Problems in the bathroom. Prolapse of the bladder and/or urethra can cause urinary stress incontinence, or involuntary leakage of urine when coughing, laughing, or exercising. Even more common is difficulty emptying the bladder. The prolapse of the bladder creates a kink or obstruction in the urethra and makes it hard to empty all of the way. This can lead to urinary infections and frequent urination. Rectocele prolapse can cause difficulty with defecation and a strong desire to strain, leading to more difficulty voiding, hemorrhoids and worsening prolapse.
Pressure in the pelvis or lower back pain. This most common symptom results from the internal pressure of pelvic organ tissue pushing against the muscles in the pelvis making the muscles ache and feel like something is “falling out.” Watch out for pain in the lower back, lower belly, groin or leg fatigue.
Pain during sex. Prolapse can cause irritation along the inside of the vulva, resulting in painful sex. In addition, the pulling from the prolapse can lead to pelvic muscle strain and soreness with intercourse. Women who are sexually active may feel uncomfortable having sex knowing that there is a bulge that is unusual in the vagina, even though the bulge is not dangerous.
There are three different types of POP:
Cystocele and urethrocele. Occurs when tissue supporting the bladder weakens and sometimes is broken, allowing the bladder and/or urethra to protrude through the ceiling of the vagina, sometimes pushing the vagina all the way to the opening or outside of the opening of the vagina.
Rectocele. Occurs when tissue supporting the ceiling of the rectum weakens or is broken and allows the rectum to bulge into the vagina, pushing the tissue out to the opening of the vagina. This causes difficulty with defecation because the stool can get trapped at the end of the rectum, in the bulge, making it hard to fully empty the rectum. Some people will push inside the vagina with their finger or on the space between the vagina and rectum to help aid redirecting the stool to come out when it gets trapped.
Uterine prolapse and Enterocele. When the ligaments supporting the uterus are weakened or stretched, it can drop down into the vagina sometimes even outside of the vagina. The same thing can occur with the top or cuff of the vagina after a hysterectomy, called an enterocele. Women who have given birth vaginally are even more at risk. Menopause, previous pelvic floor surgery, previous hysterectomy, connective tissue or nerve disorder, or obesity can also cause these types of prolapse.
Regular screenings by a urogynecologist can ensure proper and timely diagnosis. For milder cases where few (or no) symptoms are present, lifestyle changes can prevent prolapse from progressing. Kegels, yoga, pilates and weight management are recommended for maintaining a healthy pelvic floor, along with quitting smoking and not lifting heavy objects.
More severe cases of POP might call for a pessary, a plastic device that fits into the vagina and helps support the uterus, bladder, andrectum. This is recommended for women who cannot or do not wish to undergo surgery, as surgery is not recommended for women who want to have more children or who have other health conditions that make surgery higher risk.
If you’ve experienced any of the disruptive or severe symptoms of POP, your doctor may recommend surgery to repair the tissue that supports the prolapsed organ and supportive tissue around the vagina, which may also include a hysterectomy.
A urogynecologist is the best resource for answers on pelvic organ prolapse, and they’re the only doctors qualified to treat it. If you or a loved one struggles with any of these symptoms, have recently given birth and having symptoms or began menopause, call The Woman’s Center For Advanced Pelvic Surgery to make an appointment for a screening. We’re happy to answer your questions and find the treatment option that’s right for you.
Dr. Ryan Stratford is board-certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) as well as Obstetrics and Gynecology (Ob/Gyn) with a wealth of clinical and research experience.