What is Pelvic Organ Prolapse (POP)?

Pelvic Organ Prolapse (POP) is a condition in which one or more of the pelvic organs (bladder, uterus or bowel), starts to push into the walls of the vagina. This can cause the feeling of a lump or bulge in the vagina, as well as a number of symptoms mentioned below.

POP can occur when the ligaments and connective tissue that support the organs in their usual place become stretched or even torn. Weakness of the pelvic floor muscles also plays a part - if the pelvic floor muscles are not providing adequete support from below, there can be more strain and stretch on the ligaments and connective tissue supporting the organs from above.

It’s very normal for the walls of the vagina to have some degree of movement in them - they aren’t concrete after all! This is particularly true for women that have had babies. Pelvic Organ Prolapse is diagnosed when that movement becomes symptomatic and bothersome.

What are the symptoms?

Common symptoms are:

being able to feel a bulge in the vagina
sensations of vaginal fullness, heaviness, dragging or the sensation of “my insides are falling out”
lower back pain
pain during intercourse
interferences with emptying your bladder or bowel

Who is at risk?

There are a few reasons why a women may have more stretch in the ligaments and connective tissues that support the pelvic organs, or why the pelvic floor muscles aren’t able to adequately support from below. Some of these factors include vaginal births that had a long pushing stage (second stage), included the use of forceps or that involved a large bub. Women who have had prolonged extra pressure on their pelvic floor throughout their lifetime are also at risk. Examples of this are women with chronic constipation or who are obese.

Stretchy connective tissue types can also be genetic - so if your Mum or Aunties have POP, you may be at a higher risk of developing it yourself. Prolapse is also common after hysterectomy due to the uterus no longer pulling the end of the vagina upwards.

During and post-menopause can be a common time for women to experience POP symptoms for the first time. This can be due to hormonal factors (decreased estrogen) as well as age related changes to the pelvic floor muscles.

What can be done?

There are four different stages of intervention that can be undertaken for POP. If you’re considering any of these options, it’s best to have an individual assessment so that you have all the information at hand, particularly your risk factors moving forwards regarding possible progression of your prolapse.

The four choices of management are:

Do nothing - if you’re not troubled or don’t have any symptoms.. you don’t need to do anything! It’s a good idea to explore how you can best look after yourself to prevent future progression. Maintenance and prevention!
Lifestyle Modifications + Pelvic Floor Muscle Training (PFMT) - lifestyle modifications include controlling body weight, avoiding constipation and managing it when it arises and learning how to manage pressures in your abdomen. There are also external support garments available that some women find very helpful. PFMT is something that has great evidence in reducing POP symptoms in mild cases.
Pessary (+ Lifestyle modifications/ PFMT) - A pessary is a silicone device inserted into the vagina to support the walls of the vagina and the pelvic organs. Pessaries come in a variety of different shapes and sizes, and need to be fit to the individual (a bit like a new pair of glasses or shoes). The aim of using a pessary is to alleviate the sensation of a bulge in the vagina and help to reduce bothersome symptoms.
Surgery - for some women who are informed of all the choices and their risks and benefits, surgery is their best choice. In this case, your GP will need to give you a referral to a Gynaecologist. Depending on many factors, there are many different types of surgeries than can be performed. It’s important to note that surgery for POP is not always successful. It’s a great idea for women undergoing surgery for POP to link in with a pelvic floor physio both for beforehand and afterwards!

If you are experiencing symptoms of POP, please get in touch to see how I may be able to help you!