Your pelvic floor muscles undergo many changes throughout life, such as after childbirth and during menopause. In some cases, these muscles and surrounding connective tissues can weaken so much that the organs in your pelvis—including the uterus or bladder—start to sag. This is known as pelvic organ prolapse, or POP.
About 50% of women will develop POP at some point in their lives, and it’s more likely as you get older.
“It’s super, super common, but in a lot of the cases, it doesn’t actually affect the patient at all,” Whitney Horner, MD, a urogynecologist at the University of Washington Medicine in Seattle, tells SELF.
Even though POP can cause symptoms, like feeling a fullness in the vagina, pelvic pain or pressure, or bowel or urinary changes, POP isn’t always bothersome, Dr. Horner says. Just 3% to 6% of women say they have vaginal bulge symptoms, survey data shows. Many live with the condition, with mild or no symptoms.
Still, doctors say you should be aware of the possibility of POP, understand its risk factors and symptoms, and know what to do when it starts affecting your life.
What is pelvic organ prolapse?
The pelvic floor is made up of muscles, ligaments, connective tissues, and nerves that support your pelvic organs, including the bladder, uterus, vagina, small intestine, and rectum. This system keeps the organs in their proper places, according to Yale Medicine.
When the pelvic floor is weakened or damaged, pelvic organs can drop from their normal positions, causing POP, Shaun Adair, MD, a urogynecologist at Atlantic Health in Morristown, New Jersey, tells SELF.
“The vaginal tissues collapse downward, almost like the roof of a house caving in, and it can pull on the front wall, the back wall, or the top wall of the vagina,” Julia Geynisman-Tan, MD, a urogynecologist and reconstructive pelvic surgeon at Northwestern Medicine in Chicago, tells SELF.
Sometimes, the organs descend into the vagina, and, in advanced cases, protrude out of the vaginal opening, Dr. Horner says. This process typically happens gradually, Dr. Geynisman-Tan adds.
Who’s most at risk?
Age is the most common risk factor. As you get older, estrogen levels decline, which weakens tissues in the pelvis, Dr. Horner says. So POP can be common during perimenopause and menopause.
Another risk factor is pregnancy and vaginal delivery (comprising about 65% of childbirths), which can damage the pelvic floor, Dr. Adair says. “Multiple studies demonstrate that vaginal delivery, high number of pregnancies, and larger birthweight babies significantly increase the risk of prolapse.”
Medical conditions or lifestyle habits that put extra pressure on your pelvic floor can also increase your risk, including:
- Chronic constipation
- Chronic coughing
- Obesity
- Regular heavy lifting
- Connective tissue disorders
- Family history of prolapse
What are the symptoms?
Most women don’t have any symptoms, Dr. Adair says. The condition usually only becomes bothersome when the prolapse “protrudes to or past the vaginal opening,” he explains.
“It’s usually a bulge sensation or feeling of fullness” in the vagina, Dr. Horner says. Her patients have described it as “feeling like they’re sitting on a golf ball.”
Beyond that, symptoms can vary depending on which organs are dropping. For instance, Dr. Horner says, if the bladder is involved, you may struggle to pee or have leaks. When it’s the rectum, having a complete bowel movement may be difficult.
POP symptoms can also cause physical discomfort or pain or pressure during sex, Dr. Adair adds.
When you don’t have symptoms, POP isn’t much to worry about. Even if it’s caught early, such as during a pelvic exam, Dr. Geynisman-Tan says doctors will usually just watch it and wait until it progresses and symptoms arise.
So there really aren’t any “established early warning signs,” Dr. Adair says. “There is no need to routinely be screened for prolapse if you are asymptomatic, but please discuss any bulging or vaginal pressure with your provider.”
Can you prevent POP?
Addressing underlying conditions, such as chronic constipation, coughing, or urinary incontinence, could lower your risk of POP and potentially reduce the likelihood that the condition will progress, Dr. Adair says. Also, maintaining a healthy weight may help prevent the condition.
Pelvic floor muscle training is also beneficial. This includes Kegel exercises, which involve tightening and releasing pelvic muscles, Dr. Horner says. Exercises to lengthen the pelvic muscles, such as squats or figure-four stretches, also help, Dr. Geynisman-Tan says.
If you’re pregnant, talk to your doctor about your delivery plans, Dr. Geynisman-Tan says. For instance, she says a vaginal delivery may not be your best option if your mom and sister had prolapses. And Dr. Horner suggests discussing how to keep your pelvic floor healthy after the birth.
Also, if you need a hysterectomy, talk to your doctor about how they plan to support the top of the vagina once the uterus is removed to prevent prolapse, Dr. Geynisman-Tan says.
How to treat POP
POP usually isn’t treated unless it causes bulging or tissues protrude from the vagina, Dr. Geynisman-Tan says. “I really wouldn’t want women to be thinking about or worrying about it unless they’re starting to feel that.”
When these symptoms (or any pain or pressure in your pelvic area) arise, see a urogynecologist, who’s trained in pelvic floor disorders, Dr. Horner emphasizes. They’ll discuss your treatment options, which may include:
- Pelvic floor physical therapy can slow the progression of prolapse and reduce discomfort, Dr. Geynisman-Tan says. You’ll learn pelvic muscle-strengthening exercises, such as Kegels, that you can usually do at home.
- Vaginal pessary is a removable device, typically made of silicone, that’s inserted into your vagina to support your pelvic floor and any sagging organs, she adds. It is a nonsurgical option that can provide some relief from pain and discomfort.
- Vaginal estrogen is sometimes used for patients in menopause, as it can improve tissue quality and reduce dryness and irritation, which may accompany prolapse, Dr. Horner says.
- Surgery. Reconstructive surgery can be used to correct the prolapse and restore the organs to their normal positions, Dr. Adair says. A hysterectomy may also be recommended.
The best treatment “really depends on how bothered you are by your symptoms,” Dr. Horner says, but once the condition is treated, “the quality of life that people can get back is astounding.”
Too often, Dr. Horner says, women feel shame, confusion, or embarrassment about POP symptoms and may delay seeking treatment: “I want women to know that they are not alone. It’s super common. If it does happen to you, there are many ways, non-surgical and surgical, to treat it.”
Related:
- A 25-Minute Pelvic Floor Workout for Postpartum and Beyond
- How to Stop Queefing During the Worst Possible Moments
- 6 Common Behaviors Ob-Gyns Wish You’d Stop Doing
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