Pelvic organ prolapse (POP) is a condition where one or more pelvic organs shift from their ideal position. The bladder, urethra, uterus, rectum or intestines may change to a lower position within the pelvis (see pic below). This occurs from stretched, damaged or weakened connective tissue, ligaments or muscles within the pelvis.
Most common risk factors
Chronic straining occurs with chronic constipation, heavy lifting and coughing. Straining creates a high demand for the pelvic floor muscles and surrounding tissues to keep the organs in place. The prolonged downward pressure may become too strong for the tissue to resist and hence it lengthens and weakens overtime.
Childbirth may also weaken the pelvic floor due to the straining and downward pressure, but there is also a risk of tissue damage from trauma during delivery. Use of forceps or suction increases the risk of tissue damage. Larger babies and multiple births also increases the chance of developing POP.
Heavy lifting without proper technique during exercise, work or your daily life. There is an increased intra abdominal pressure that occurs with heavy lifting. As mentioned above, that added pressure creates a high demand on the pelvic floor. If done with poor posture or form, the pelvic floor may not be working optimally and fail to match the demands from above.
Weakened tissues (abdominal or pelvic floor) from surgery, Diastasis Recti Abdominis, menopause or if you have a condition known as Ehlers Danlos Syndrome ("stretchy connective tissue"). This makes you more prone to developing POP as well.
Who does it affect?
It's estimated that approximately 50% of women that have had children present with some type of POP. When based on symptoms, POP has a prevalence of 3-6%, but up to 50% when based upon vaginal exam. This shows how many people have POP prior to symptoms popping up! {Pun intended}
Symptoms
Not all POPs are created equal and many women don't have any symptoms at all. Common signs that you may have POP are:
A feeling of heaviness in your pelvis
Feeling "different" in down below
A sensation of "extra tissue" in the vaginal canal
Trouble keeping in a tampon or menstrual cup
Low back pain
Leaking urine or having to go again right after you get up from peeing
Needing to splint (use a finger to push near the vagina) to poo
Painful intercourse
Increased discomfort with prolonged standing and relieved with lying down
Treatment
Luckily, most types of POP don't require surgery and can be treated with lifestyle changes, toileting habit modifications, physical therapy, exercises or the use of a pessary for support. Physical therapists coach you through movement variations to get back to tasks that matter to you, teach you strategies to coordinate your pelvic floor during your daily routine, and gives you the confidence to resume activities you enjoy.
Below are images of pessaries and how they fit into the vaginal canal to support the organs.
Although some people require surgery, the failure rate is high because the root cause was never corrected. Post surgical physical therapy facilitates a more successful outcome by addressing the above mentioned habits. Don't wait for your pelvic organs to "drop it like it's hot", get an assessment and treatment at the start of symptoms.