Pelvic Prolapse

Pelvic Prolapse

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Pelvic organ prolapse (POP) is a condition where weakened muscles in your pelvis cause one or more organs in your pelvis (vagina, uterus, bladder and rectum) to sag. In more severe cases, an organ bulges onto another organ or outside your body. Your healthcare provider can recommend treatments to repair your prolapse and relieve symptoms.

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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?

Friedman T, Eslick GD, Dietz HP. Risk factors for prolapse recurrence: systematic review and meta-analysis. (https://pubmed.ncbi.nlm.nih.gov/28921033/) Int Urogynecol J . 2018;29(1):13-21. Accessed 8/22/2022.
Kudish BI, Iglesia CB, Gutman RE, et al. Risk factors for prolapse development in white, black, and Hispanic women. (https://pubmed.ncbi.nlm.nih.gov/22453694/) Female Pelvic Med Reconstr Surg . 2011;17(2):80-90. Accessed 8/22/2022.
Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. (https://pubmed.ncbi.nlm.nih.gov/18799443/) JAMA . 2008;300(11):1311-1316. Accessed 8/22/2022.
Whitcomb EL, Rortveit G, Brown JS, et al. Racial differences in pelvic organ prolapse. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879888/) Obstet Gynecol . 2009;114(6):1271-1277. Accessed 8/22/2022.

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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.

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The type of prolapse you have depends on where the weaknesses are in your pelvic floor and what organs are affected.
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.
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.
The most common symptom is feeling a bulge in your vagina, as if something were falling out of it. Other symptoms include:
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:
Your pelvic floor can weaken for many reasons. A weak pelvic floor increases your likelihood of a prolapse.
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.
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.
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.
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.
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.
Many causes of POP are out of your control. But you can put healthy habits into place to reduce your risk.
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.
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.
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.
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.
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.
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.
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.
Last reviewed by a Cleveland Clinic medical professional on 08/22/2022.

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One of the most uncomfortable—and awkward—conditions that afflicts women is pelvic organ prolapse. Normally, the pelvic organs—the bladder, uterus, vagina, and rectum—are supported and held in place by a group of muscles and tissues called the pelvic floor. When these muscles weaken over time, the pelvic organs can droop down and bulge out of the vagina.
In addition to the sensation of feeling an uncomfortable bulge in the vagina, you can experience symptoms such as
In pelvic organ prolapse, the pelvic floor
muscles weaken, causing one or more of the
pelvic organs to fall downward into or out of
the vagina.
How prolapse is named depends on which organ is affected:
Most of the time, pelvic organ prolapse is the result of carrying—and vaginally delivering—children, which weakens the pelvic floor. "The baby's head going through the vaginal canal stretches out the connective tissues," says Dr. May Wakamatsu, assistant professor at Harvard Medical School and division director of Female Pelvic Medicine and Reconstructive Surgery at Massachusetts General Hospital.
Getting older, being overweight, and having a condition that involves frequent coughing (which increases pressure in the abdomen and pelvis) also make a woman vulnerable to prolapse.
In pelvic organ prolapse, the pelvic floor muscles weaken, causing one or more of the pelvic organs to fall downward into or out of the vagina.
If you have pelvic organ prolapse, you'll notice a bulge at the opening of the vagina. The bulge isn't dangerous, but it can be very uncomfortable.
When the prolapse pulls the bladder downward, it bends the ureter (the tube through which urine exits the body). As a result, you might have trouble urinating fully. "It's like bending a garden hose," Dr. Wakamatsu says. Likewise, if the prolapse pulls the rectum downward, it can cause constipation.
As embarrassing as pelvic organ prolapse can be to talk about, it's something you need to discuss with your primary care physician or gynecologist. Letting it go can leave urine in your bladder, which can lead to urinary tract infections.
The first treatment your doctor might recommend is pelvic floor physical therapy, which may include Kegel exercises . You squeeze and release the muscles you use to hold in gas, which strengthens the muscles that help to support the pelvic organs.
It's important to do Kegels the right way, Dr. Wakamatsu says. A physical therapist can use techniques like biofeedback to help you find the right muscles to squeeze. Physical therapy with Kegels may be enough to relieve prolapse symptoms.
Your doctor might also recommend a device called a pessary . Pessaries are made from silicone and come in many different shapes. The pessary is inserted into the vagina to help support the prolapsed organs. It is usually fitted to you, and it's removable.
Surgery is an option for women who aren't comfortable with the idea of using a pessary, or who have tried it and found it didn't relieve their symptoms. There are several different types of surgery, based on the location and severity of the prolapse and other health issues. For women who have uterine prolapse, often a hysterectomy (removing the uterus) is recommended. Women who are at high risk for repeated prolapse may have a procedure called sacrocolpopexy, in which the surgeon works through small incisions in the abdomen to reposition the pelvic organs back where they should be.
"Women should lose weight if they're overweight. They should stop smoking because it can lead to repetitive coughing," Dr. Wakamatsu says. "And they should protect their pelvic floor by pulling in their lower abdominal muscles and tightening their pelvic floor muscles when they lift heavy objects."
Image: © FilippoBacci | GettyImages

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Medically Reviewed by Neha Pathak, MD on September 20, 2021
Pelvic organ prolapse, a type of pelvic floor disorder, affects almost 3% of U.S. women. Some women have more than one pelvic floor disorder.
The "pelvic floor" is a group of muscles that form a kind of hammock across your pelvic opening. Normally, these muscles and the tissues surrounding them keep the pelvic organs in place. These organs include your bladder , uterus, vagina , small bowel, and rectum.
Sometimes, these muscles and tissues develop problems. Some women develop pelvic floor disorders following childbirth . And as women age, pelvic organ prolapse and other pelvic floor disorders become more common.
When pelvic floor disorders develop, one or more of the pelvic organs may stop working properly. Conditions associated with pelvic floor disorders include:
"Prolapse" refers to a descending or drooping of organs. Pelvic organ prolapse refers to the prolapse or drooping of any of the pelvic floor organs, including the:
These organs are said to prolapse if they descend into or outside of the vaginal canal or anus . You may hear them referred to in these ways:
Anything that puts increased pressure in the abdomen can lead to pelvic organ prolapse. Common causes include:
Genetics may also play a role in pelvic organ prolapse. Connective tissues may be weaker in some women, perhaps placing them more at risk.
Some women notice nothing at all, but others report these symptoms with pelvic organ prolapse:
Symptoms depend somewhat on which organ is drooping. If the bladder prolapses, you may leak urine. If it's the rectum, you may have constipation and uncomfortable intercourse. A backache as well as uncomfortable intercourse often accompanies small intestine prolapse. Uterine prolapse is also accompanied by backache and uncomfortable intercourse.
In most cases, symptoms are mild in the morning but get worse as the day goes on.
If you think you may have pelvic organ prolapse , talk to your doctor. They’ll ask about your medical history and examine your pelvic organs to get an idea of how strong your pelvic floor muscles are. It may be all they need to do to make a diagnosis.
Your doctor may also discover pelvic organ prolapse during a routine pelvic exam, such as the one you get when you go for your Pap smear .
Your doctor may order a variety of tests if they suspect pelvic organ prolapse. They may also want to find out if more than one organ has moved out of place, how severe the prolapse is, and whether you have other related conditions. The tests might include:
Treatment of pelvic organ prolapse depends on how severe the symptoms are. Treatment can include a variety of therapies, including:
Many risk factors for pelvic organ prolapse are out of your control. These include:
But you can reduce the likelihood you will have problems. Try these steps:
Be careful with heavy lifting; use your legs, not your back or abs
Magee-Womens Research Institute Center for Research in Women's Bladder & Pelvic Health, Pittsburgh, Pa: "Pelvic Organ Prolapse."
National Institutes of Health's National Institute of Child Health & Human Development: "Research on Gynecological Disorders," “Pelvic Floor Disorders: Condition Information.”
National Association for Continence: "Pelvic Organ Prolapse."
American Urogynecologic Society: “POP Symptoms & Types,” “Pelvic Organ Prolapse,” “Can I Prevent POP?” “Physical Therapy,” “Vaginal Devices – Pessary.”
Mayo Clinic: “Uterine Prolapse,” “Pelvic Organ Prolapse.”
University of Virginia: “Pelvic Organ Prolapse.”
National Institute of Diabetes and Digestive and Kidney Diseases: “Cystocele (Prolapsed Bladder).”
Cleveland Clinic: “Pelvic Organ Prolapse,” “What to Do About Dropped Bladder?”
American Congress of Obstetricians and Gynecologists: “Surgery for Pelvic Organ Prolapse.”
Baylor College of Medicine: “Anterior and Posterior Repair (Colporrhaphy),” “Laparoscopic Pelvic Organ Prolapse Surgery,” “Prolapse Surgery.”
International Urogynecological Association: “Sacrospinous fixation/Uterosacral Ligament Suspension,” “Sacrocolpopexy” “Vaginal Repair with Mesh.”
UpToDate: “Pelvic Organ Prolapse in Women: Obliterative Procedures (Colpocleisis).”
FDA press release, January 4, 2016.
Beth Israel Deaconess Medical Center: “Pelvic Organ Prolapse.”
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