Pelvic Organ Prolapse

What is pelvic organ prolapse?

Pelvic organ prolapse (POP) is a condition in which your pelvic floor (the muscles, ligaments and tissues that support your pelvic organs) become too weak to hold your organs in place. Your pelvic floor muscles act like a powerful sling that supports organs like your vagina, uterus, bladder and rectum. If these muscles become too loose or sustain damage, the organs they support shift out of place.

With mild cases of POP, your organs may drop. In more severe cases, they may extend outside your vagina and cause a bulge.

Pelvic organ prolapse is one type of pelvic floor disorder, along with urinary and fecal incontinence. Sometimes these other disorders occur together with POP.

What are the different types of pelvic organ prolapse?

The type of prolapse you have depends on where the weaknesses are in your pelvic floor and what organs are affected.

• Anterior vaginal wall prolapse (dropped bladder): Weakened pelvic floor muscles above your vagina can cause your bladder to slip out of place and bulge onto your vagina. This type of prolapse is also called cystocele. Anterior vaginal wall prolapse is the most common type of POP.
• Urethrocele: Weakened pelvic floor muscles can cause the tube that carries pee from your bladder to outside your body (urethra) to droop. A dropped urethra often accompanies a dropped bladder.
• Posterior vaginal wall prolapse (dropped rectum): Weakened pelvic floor muscles in between your vagina and rectum can cause your rectum to bulge onto the back wall of your vagina. This type of prolapse is also called rectocele.
• Enterocele: Weakened muscles in your pelvis can cause your small intestine to bulge onto the back wall or the top of your vagina.
• Uterine prolapse (dropped uterus): A weakened pelvic floor can cause your uterus to drop down into your vaginal canal.
• Vaginal vault prolapse: Weakened pelvic floor muscles can cause the top part of your vagina (vaginal vault) to drop into your vaginal canal.

Who is affected by pelvic organ prolapse?

People of all sexes can experience POP, but you’re at greater risk if you’re a woman or person assigned female at birth (AFAB). Men and people assigned male at birth (AMAB) can experience a dropped bladder and a dropped rectum.

How common is pelvic organ prolapse?

Around 3% to 11% of people AFAB experience POP. About 37% of people with pelvic floor disorders, including POP, are between ages 60 and 79. Over half are 80 or older. POP doesn’t always cause symptoms, though. As a result, it’s hard to know how common POP is among people who don’t see their healthcare providers for symptom relief.

What are the symptoms of pelvic organ prolapse?

The most common symptom is feeling a bulge in your vagina, as if something were falling out of it. Other symptoms include:

• Bulge, fullness or pressure in your vagina.
• Fullness, pressure or aching in your pelvis.
• Aching or pain in your low back.
• Pressure, hitting sensation or pain during intercourse (dyspareunia).
• Bulge or pressure that worsens throughout the day.
• Bulge or pressure that worsens if you cough or if you’re on your feet too long.
• Having to shift protruding organs with your finger in order to pee or poop.
• Vaginal spotting.

Your symptoms depend on where your prolapse is located. Telling your healthcare provider about your symptoms helps them locate the spots where your pelvic floor is weakest.

Stress incontinence, urge incontinence and fecal incontinence often coexist with POP because they share similar risk factors. Symptoms include:

• Leaking pee when you cough, laugh or exercise (stress incontinence).
• A frequent urge to pee that’s hard to control (urge incontinence).
• Constipation or being unable to control when you poop (fecal incontinence).

What causes pelvic organ prolapse?

Your pelvic floor can weaken for many reasons. A weak pelvic floor increases your likelihood of a prolapse.

• Vaginal childbirth is the most common factor associated with developing POP. Multiple vaginal deliveries, having twins or triplets, or carrying a larger than average fetus (fetal macrosomia) all increase the odds that your pelvic floor muscles will sustain injuries that may lead to POP.
• The aging process can cause your muscles to lose strength, including your pelvic floor muscles. One factor is declining estrogen. During menopause, your body produces less estrogen. The decline can cause the connective tissues that support your pelvic floor to weaken.
• Having a heavier body increases your risk for POP. Studies have shown that people who are clinically overweight or have obesity are more likely to develop POP than people who are in the normal weight range.
• Long-term pressure in your abdominal cavity can overwork your pelvic floor muscles, causing them to weaken. Chronic constipation, chronic coughing and frequent heavy lifting all increase your chance of developing POP.
• A family history of POP may increase your odds of developing POP. Research into the genetic components of POP is ongoing, but it’s possible that you inherited a weaker pelvic floor.
• Collagen irregularities can weaken the connective tissues in your pelvic floor, increasing the likelihood you’ll develop POP. People with connective tissue disorders, like Ehlers-Danlos Syndrome, and who have more movement in their joints are at a greater risk for developing POP.

How is pelvic organ prolapse diagnosed?

During your appointment, your healthcare provider will review your symptoms and perform a pelvic exam. During the exam, your provider may ask you to cough so that they can see the full extent of your prolapse when you’re straining and when you’re relaxed. They may examine you while you’re lying down and while you’re standing. Often, a pelvic exam is all it takes to diagnose a prolapse.

Additional tests may include:

• Bladder function tests that allow your provider to look for signs of urinary issues that are common with POP. Tests may include a cystoscopy, a procedure that allows your provider to see inside your bladder and urethra. Your provider may also perform a urodynamics test to see how well your bladder and urethra are storing and releasing pee.
• Imaging procedures that allow your provider to view inside your pelvic cavity. Your provider may order a pelvic floor ultrasound or MRI to determine the extent of your prolapse. Imaging isn’t often used except in complex cases.

What is the staging system for pelvic organ prolapse?

The Pelvic Organ Prolapse Quantification (POP-Q) system classifies POP based on how mild or severe your prolapse is. The scale ranges from zero to four. Stage Zero means your organs haven’t shifted out of place at all. Stage Four means you have a complete prolapse. A complete prolapse is the most severe kind. It may involve an organ bulging out of your body.

Both the type of prolapse and the extent of the prolapse will shape your treatment.

How is pelvic organ prolapse treated?

Because any surgical procedure may pose risks or create complications, nonsurgical procedures are usually the first line of treatment for POP. If more conservative treatments don’t work, your provider may recommend surgery.

Nonsurgical treatments

Treatments include:

• Vaginal pessary: A removable silicone device that your provider can insert into your vagina to hold a sagging organ in place.
• Pelvic floor exercises (Kegel exercises): Strengthening exercises for your pelvic floor. Your provider may refer you to a physical therapist to test the strength of individual muscles and teach you targeted exercises to train these muscles.

Surgical treatments

Surgery may be an option if your symptoms haven’t improved with conservative treatments and if you no longer wish to have children. Childbirth following surgery may increase the risk of your prolapse returning.

Two types of surgeries are available: obliterative surgery and reconstructive surgery. Obliterative surgery sews your vaginal walls shut, preventing organs from slipping out. Reconstructive surgery repairs the weakened parts of your pelvic floor.

• Colpocleisis is an obliterative procedure that results in a shortened vagina. It prevents any organs from bulging outside your body. It’s a good option if you’re too frail for reconstructive surgery and don’t wish to have penetrative sex anymore.
• Colporrhaphy treats anterior and/or posterior vaginal wall prolapse. With colporrhaphy, your healthcare provider performs surgery through your vagina. They reinforce your vaginal walls with dissolvable sutures to support your bladder and rectum.
• Sacrocolpopexy treats vaginal vault prolapse and enterocele. It may involve an incision into your abdomen or a less invasive procedure, called laparoscopy. During the procedure, your provider attaches surgical mesh on your vaginal walls and then attaches it to your tailbone. The mesh lifts your vagina back into place.
• Sacrohysteropexy treats uterine prolapse. Your provider attaches surgical mesh to your cervix and vagina and attaches it to your tailbone, lifting your uterus into place. Sacrohysteropexy is an option if you don’t want to have your uterus removed (a hysterectomy).
• Uterosacral or sacrospinous ligament fixation uses your tissues to treat uterine prolapse or vaginal vault prolapse. Like colporrhaphy, it’s performed through your vagina. During the procedure, your provider attaches the top of your vagina to a ligament or muscle in your pelvis, using dissolvable sutures. This type of surgery is sometimes called native tissue repair.

Your provider may suggest additional procedures while you’re in surgery for POP. For instance, some procedures may require a hysterectomy so that pelvic floor muscles can be accessed and repaired. Your provider may treat other conditions that may accompany POP, like stress urinary incontinence, during surgery.

How can I prevent pelvic organ prolapse?

Many causes of POP are out of your control. But you can put healthy habits into place to reduce your risk.

• Do pelvic floor exercises daily. Having muscle control in your pelvic floor provides stronger support for your organs.
• Maintain a healthy weight. Talk to your provider about what a healthy weight means for you.
• Prevent constipation. Chronic constipation can strain your pelvic floor muscles. Choosing a high-fiber diet and drinking plenty of fluids can help prevent constipation.
• Don’t smoke. Smoking can lead to chronic coughing, which can put undue pressure on your abdominal cavity and strain your pelvic floor muscles.
• Protect your pelvic floor when you lift. Get help lifting heavy objects. When lifting alone, bend your hips and knees to squat while keeping your back as straight as possible. Don’t twist your torso while you’re lifting. Correctly positioning your body prevents injury to your low back and protects your pelvic floor, too.

What can I expect if I have pelvic organ prolapse?

Your prognosis depends on your prolapse (where it’s located, it’s severity) and your goals (to have children, to continue having penetrative sex, to have a less invasive surgery, etc.). Talk to your healthcare provider about how your prolapse shapes your treatment options. Discuss how the benefits of treatment will allow you to achieve your goals, and ask about any risks that may prevent you from achieving them, too. Grounding your expectations in honest conversations with your provider will improve your experience with POP.

What happens if my prolapse is left untreated?

Left untreated, your prolapse and your symptoms can worsen. Your healthcare provider can monitor your prolapse and recommend treatments if it progresses to the point where it’s negatively impacting your quality of life.

What questions should I ask my provider?

• What type of POP do I have?
• Will I be able to manage POP symptoms without surgery?
• What surgical options are available to treat my POP?
• What are the success rates associated with the POP surgical options available to me?
• What is the likelihood that surgery will relieve all my symptoms?
• What are the potential side effects of surgery?
• Will treatment negatively impact my sex life?

What is the most common symptom of pelvic organ prolapse?

Most people with POP describe a feeling of bulge, fullness or pressure in their vagina, as if something were falling out. Your symptoms will depend on what type of prolapse you have and how severe it is.

How do you check for pelvic organ prolapse?

Common symptoms like pressure or fullness in your vagina or issues related to incontinence may be signs of a prolapse. Your provider can diagnose POP during a pelvic exam.

Does pelvic organ prolapse go away?

It can, with treatment. With mild POP, you can strengthen your muscles so that they hold the organs in their correct locations. Reconstructive surgeries strengthen the weaknesses in your pelvic walls so that your organs return to their original locations.

Can I push my prolapse back up?

With more severe prolapse, you may have to push the bulging organ out of the way to poop or pee. The fix is temporary. See your healthcare provider for treatment if your prolapse is this severe.

A note from Cleveland Clinic

Pelvic organ prolapse can harm your body image and your sexuality. It can cause symptoms that prevent you from living your life to the fullest. But POP isn’t something you have to accept. Don’t be embarrassed to talk to your healthcare provider if you have POP symptoms or if you suspect you have a weakened pelvic floor. They can suggest procedures, medical devices and even lifestyle modifications that can repair your prolapse and improve your quality of life.