5 Things I Wish All Women Knew About Pelvic Organ Prolapse
An ob-gyn discusses common prolapse symptoms and treatment options.
Pelvic organ prolapse (POP) doesn’t get talked about much. One reason is that women often feel shame or confusion about the condition or its treatments. And a lot of women have never even heard of it. As an ob-gyn, I’m working to change all of this.
POP happens when one or more pelvic organs (the vagina, uterus, bladder, urethra, small intestine, and rectum) drop from their normal position. (Read Pelvic Support Problems for all the details.) It’s caused by a weak pelvic floor, the collection of muscles, ligaments, and connective tissues that hold these organs in place.
When a pelvic organ drops, it may bulge into another organ. In some cases, the organ may bulge out of the vagina. Women may accidentally leak urine or bowel contents (stool), or their vagina may make noises during exercise or sex. These symptoms and others can be isolating. Some women don’t seek treatment until they start having serious problems with bladder, bowel, or sexual function.
Ob-gyns and urogynecologists, who specialize in pelvic floor disorders, can help. I treat women with POP regularly in my practice. Many come to me after sharing their symptoms with a mother, sister, or friend who went through the same thing and told them how they got help.
Here are five things I’d like all women to know about POP.
1. If you have POP, you’re not alone.
POP affects 1 in 4 women in their 40s and 1 in 3 in their 60s. By the time women reach their 80s, POP affects half of all women.
It’s often caused by changes during pregnancy and childbirth that weaken the pelvic floor. But women who have never given birth can have POP too. It runs in families and can be caused by many factors, including
changes in hormones with menopause
diseases that weaken connective tissue, including genetic disorders
pelvic floor injuries
Other conditions and habits that strain pelvic floor muscles also can lead to POP. These include
ongoing constipation and straining during bowel movements
continual coughing caused by smoking or lung disease
very high-impact exercise or jobs that require heavy lifting
2. There are many symptoms of POP, which usually develop over time.
Occasionally POP happens suddenly. For example, a woman could be doing squats at the gym that cause the last bit of support from weak connective tissue to give way. Then she’ll see something pink hanging out of her vagina.
More often, POP starts with symptoms such as leaking urine or not being able to empty the bladder completely. You may have back pressure or pain. Sex may hurt. You may have a feeling of laxity (looseness) within the vagina, or you may have more difficulty reaching orgasm.
POP can worsen or lead to constipation. If a woman’s rectum has bulged into her vagina, she may have other bowel problems. For example, she may need to insert her fingers into her vagina and push against the walls of the vagina to move stool out through the anus.
3. We have good treatment options for POP, but you may not need all of them.
Women should work with a urogynecologist or pelvic floor specialist to match treatment with their needs and wishes. And if POP isn’t bothering you, you may not need any treatment at all.
There are a few things you can do that may help you feel or function better. These include
adding fiber to your diet and drinking lots of water to make bowel movements easier
losing a few pounds if needed to take pressure off pelvic organs
doing exercises such as yoga and Pilates to build core strength
Then there are other treatments we can explore:
Pessaries—You may get all the relief you need with these simple devices that fit inside your vagina and support pelvic organs. Pessaries often help with bulging symptoms and leaking urine.
Pelvic floor exercises—Kegel exercises strengthen muscles around the vagina, urethra, and rectum. But many women do them incorrectly. They push down instead of pulling up, which can make POP worse. A pelvic floor physical therapist can use sensors to measure your muscle strength and teach you to do the exercises correctly. There also are similar devices you can buy to use at home.
Surgery—You may need surgery if POP affects your quality of life. Many women are bothered when an organ bulges out of the vagina. It can feel like you’ve got a tampon half in and half out. Or it may be time to consider surgery if you’re leaking urine or stool, have pain, or can no longer hold in a pessary. (Read Surgery for Pelvic Organ Prolapse.)
4. See a board-certified urogynecologist if you can.
They are experts in pelvic floor health and function. Together you can discuss all the treatment options for POP.
Although POP rarely gets talked about, there’s heavy marketing of cosmetic procedures such as vaginal rejuvenation. Women hear about these procedures and think or are told they can help with POP symptoms. This is not true. They actually can be harmful.
These cosmetic procedures are not meant to fix your pelvic floor function. Insurance doesn’t cover them. I’ve had patients who have paid thousands of dollars for cosmetic procedures that give them no relief. Remember, POP is a medical condition with treatment that should be covered by insurance (even surgery).
5. The postpartum period is a good time to check your pelvic floor health.
The “fourth trimester,” or the weeks after pregnancy, is a great opportunity to talk with your ob-gyn about any changes in your pelvic muscles.
It’s also a good time for care that may help prevent POP. This could mean seeing a pelvic floor therapist, changing your diet to help with constipation or weight loss, or using a pessary.
Remember, your pelvic floor health is an important part of your overall well-being. Together with your ob-gyn, you can give your pelvic floor the attention and care that you need.
Published: December 2021
Last reviewed: December 2021
Copyright 2022 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.
This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.