Pelvic organ prolapse (POP) occurs when the tissue and muscles of the pelvic floor no longer support the pelvic organs resulting in the drop (prolapse) of the pelvic organs from their normal position. The pelvic organs include the vagina, cervix, uterus, bladder, urethra, and rectum. The bladder is the most commonly involved organ in pelvic organ prolapse.

Supporting muscles and tissue of the pelvic floor may become torn or stretched because of labor or childbirth or may weaken with age. Other risk factors for POP include: genetic predisposition, connective tissue disorder, obesity and frequent constipation.

Many women have some degree of POP, although not all women have symptoms. Women who have symptoms may experience pelvic discomfort or pain, pressure and other symptoms including:

• bulge of tissue or organs that protrudes to or past the vaginal opening
• leakage of urine (urinary incontinence)
• sexual difficulties

It is important for women to consult with their health care provider for proper diagnosis of POP.

The pelvic muscles and tissues support the pelvic organs like a hammock. The pelvic organs include the bladder, uterus and cervix, vagina, and rectum, which is part of the bowel. A prolapse happens when the pelvis muscles and tissues can no longer support these organs because the muscles and tissues are weak or damaged. This causes one or more pelvic organs to drop or press into or out of the vagina.

Pelvic organ prolapse is a type of pelvic floor disorder. The most common pelvic floor disorders are:

• Urinary incontinence (leaking of urine)
• Fecal incontinence (leaking of stool)
• Pelvic organ prolapse (weakening of the muscles and tissues supporting the organs in the pelvis)

The different types of pelvic organ prolapse depend on the pelvic organ affected. The most common types include:

• Dropped bladder (called cystocele). This is the most common type of pelvic organ prolapse. This happens when the bladder drops into or out of the vagina.
• Rectocele. This happens when the rectum bulges into or out of the vagina.
• Dropped uterus (uterine prolapse). This happens when the uterus bulges into or out of the vagina. Uterine prolapse is sometimes associated with small bowel prolapse (called enterocele), where part of the small intestine, or small bowel, bulges into the vagina.

Although it is rare, pelvic organ prolapse can also happen after a hysterectomy. Any part of the vaginal wall may drop, causing a bulge into or out of the vagina.

Pelvic floor disorders (urinary incontinence, fecal incontinence, and pelvic organ prolapse) affect one in five women in the United States. Pelvic organ prolapse is less common than urinary or fecal incontinence but affects almost 3% of U.S. women. Pelvic organ prolapse happens more often in older women and in white and Hispanic women than in younger women or women of other racial and ethnic groups.

Some women develop more than one pelvic floor disorder, such as pelvic organ prolapse with urinary incontinence.

Pelvic organ prolapse happens when the muscles or connective tissues of the pelvis do not work as they should. The most common risk factors are:

• Vaginal childbirth, which can stretch and strain the pelvic floor. Multiple vaginal childbirths raise your risk for pelvic organ prolapse later in life. But you can get prolapse even if you have never had children or if you had a cesarean, or C-section, delivery.
• Long-term pressure on your abdomen, including pressure from obesity, chronic coughing, or straining often during bowel movements
• Giving birth to a baby weighing more than 8½ pounds
• Aging. Pelvic floor disorders are more common in older women. About 37% of women with pelvic floor disorders are 60 to 79 years of age, and about half are 80 or older.
• Hormonal changes during menopause. Loss of the female hormone estrogen during and after menopause can raise your risk for pelvic organ prolapse. Researchers are not sure exactly why this happens.
• Family history. Researchers are studying how genetics can play a role in pelvic organ prolapse.

The pressure from prolapse can cause a bulge in the vagina that can sometimes be felt or seen. Women with pelvic organ prolapse may feel uncomfortable pressure during physical activity or sex.

Other symptoms of pelvic organ prolapse include:

• Seeing or feeling a bulge or "something coming out" of the vagina
• A feeling of pressure, discomfort, aching, or fullness in the pelvis
• Pelvic pressure that gets worse with standing or coughing or as the day goes on
• Leaking urine (incontinence) or problems having a bowel movement
• Problems inserting tampons

Some women say that their symptoms are worse at certain times of the day, during physical activity, or after standing for a long time. Talk to your doctor or nurse about your symptoms.

Your doctor will talk to you about your symptoms and do a pelvic exam. You may be asked to strain or cough during the exam so your doctor can see whether these actions cause prolapse or urine leakage. Your doctor may also do other tests to see whether you can completely empty your bladder when you go to the bathroom.

Treatment for pelvic organ prolapse depends on the type of prolapse you have, your symptoms, your age, other health problems, and whether you are sexually active.

Your treatment may include one or more of the following:

• Pessary. A pessary is a removable device inserted into the vagina to support the pelvic organs. Pessaries come in many different shapes and sizes. Pessaries are often the first treatment your doctor will try. Certain types of pessaries can treat both pelvic organ prolapse and urinary incontinence.
• Pelvic floor muscle therapy. Your doctor may show you how to do pelvic floor exercises or refer you to a physical therapist to do exercises to help strengthen the pelvic floor muscles. Pelvic floor muscle exercises can also help women who have pelvic organ prolapse as well as urinary incontinence.
• Changing eating habits. If you have bowel problems, your doctor may recommend eating more foods with fiber. Fiber helps prevent constipation and straining during bowel movements. Learn more about ways to treat fecal incontinence.
• Surgery to support the uterus or vagina. During surgery, your doctor may use your own body tissue or synthetic mesh to help repair the prolapse and build pelvic floor support. This type of surgery is recommended for sexually active women with serious prolapse of the vagina or uterus. Surgery for prolapse can be done through your vagina or abdomen. Your doctor may use synthetic mesh to repair the prolapse through the abdomen. But, because of safety issues, mesh is no longer used to repair the prolapse through the vagina.
• Surgery to close the vagina. This surgery, called colpocleisis, treats prolapse by closing the vaginal opening. This can be a good option for women who do not plan to have or who no longer have vaginal intercourse.

After obtaining a detailed medical history and completing a thorough physical exam, your health care provider can recommend treatment options for your pelvic organ prolapse (POP). Nonsurgical or surgical treatment is usually effective but it may not completely solve all symptoms associated with POP such as pelvic pain or pressure.

NONSURGICAL TREATMENT OPTIONS

Examples of nonsurgical 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.
• Pessary: A removable device that is inserted into the vagina to support the pelvic organ(s) that have prolapsed.

SURGICAL TREATMENT OPTIONS

Not every woman with POP will need surgery. Surgery may be recommended for women with significant discomfort or pain from POP that impairs their quality of life. If surgery is recommended, factors to consider include:

• which organ(s) have prolapsed
• severity of prolapse
• desire for future children
• age
• sexual activity
• severity of symptoms

Surgery to repair POP can be done through either the vagina or abdomen, using stitches (sutures) alone or with the addition of surgical mesh. Surgical options include restoring the normal position of the vagina, repairing the tissue around the vagina, permanently closing the vaginal canal with or without removing the uterus (colpocleiesis).

It is also possible that women with POP may experience problems with urine leakage (incontinence). During surgery, a procedure to prevent or decrease urine leakage (which may also use surgical mesh) may be performed.

Mesh used to repair pelvic organ prolapse through the abdomen is safe. But, because of safety issues, mesh is no longer used to repair prolapse through the vagina.

If you had surgery with mesh to repair pelvic organ prolapse through the vagina, you may not need to do anything if you do not have any symptoms or problems. Talk to your doctor or nurse if you notice any symptoms or problems, such as vaginal bleeding or discharge, pelvic pain, or pain during sex.

If you had surgery with mesh to repair your POP transvaginally, you should:

• Continue with your annual and other routine check-ups and follow-up care. There is no need to take additional action if you are satisfied with your surgery and are not having complications or symptoms.
• Notify your health care provider if you have complications or symptoms develop, such as persistent vaginal bleeding or discharge, pelvic or groin pain, or pain during sexual intercourse.
• Let your health care provider know you have surgical mesh, especially if you plan to have another surgery or other medical procedures.
• Talk to your health care provider about any questions you may have.

If you have had transvaginal POP surgery but do not know whether your surgeon used mesh, ask your surgeon at your next scheduled visit.

Researchers are studying ways to prevent pelvic organ prolapse. The following steps may reduce your risk of getting a pelvic floor problem:

• Maintain a healthy weight or lose weight (if you are overweight). Women who have overweight or obesity are more likely to have pelvic floor problems.
• Choose foods with fiber. Fiber helps prevent constipation and straining during bowel movements. Preventing constipation may reduce the risk of some pelvic floor disorders.
• Do not smoke. Smoking can lead to chronic cough, which puts stress on the pelvic floor muscles.