What is pelvic organ prolapse?
Pelvic organ prolapse occurs when any (or any combination) of the pelvic organs fall or droop from their regular place in the body. It might include the bladder, uterus, vagina, or rectum. And although prolapse can make itself known in many ways—sometimes it just causes mild discomfort or isn’t felt at all—it often results in organs seemingly falling out of place in the body or creating visible bulges coming out of the vagina. Although that sounds terrifying, the good news (yes, there can be good news!) is that these bulges aren’t dangerous, prolapse is treatable, and it’s also quite common—so you’re definitely not alone. One in three women experience prolapse of some kind throughout their lives.
“Pelvic organ prolapse” is a fairly general term, but there are several types, depending on which organs are affected:
- Cystocele occurs when the bladder falls into the vagina (and is the most common type of prolapse)
- Rectocele occurs when the rectum bulges into the back wall of the vagina
- Uterine prolapse occurs when the uterus falls into the vagina
- Vaginal vault prolapse happens when the top part of the vagina droops into the bottom of the vaginal canal
Often, multiple types of prolapse occur together, and one can often influence the other. So it’s important to get checked out for all of it.
What causes pelvic organ prolapse?
The reason the pelvic organs can move around so much in the first place is that the pelvic muscles form a sort of floor or sling that holds these organs in place. When those muscles weaken, they’re unable to give that necessary support. This weakening can happen for a lot of reasons, including pregnancy and childbirth, age, obesity, hysterectomy, or even respiratory problems that lead to frequent coughing.
What happens to the body during pelvic organ prolapse?
You might not immediately know you’re experiencing pelvic organ prolapse, because the symptoms might come on gradually or not be felt until they become quite severe. Some women also just assume it’s normal and comes with aging. In the early stages, you might experience backaches, painful sex, constipation, or UTIs, which come from the (falling) bladder being unable to empty completely because it’s bending the urethra.
If that’s not bad enough, many people who have prolapse also find themselves experiencing some bladder leakage. One study found that up to 60 percent of women with prolapse also have stress urinary incontinence (SUI), and nearly 40 percent of women with UI also have pelvic organ prolapse, to some degree. SUI leaks can happen during activities like exercise, heavy lifting, laughing, sneezing, or coughing, because the pelvic muscles aren’t properly holding the urethra closed. In some ways, it’s not surprising the two conditions coexist because it all comes down to the same root: a weakened pelvic floor.
When prolapse becomes severe, the organs may drop so low that they visibly protrude from the vagina. Though it may be uncomfortable, or cause painful sex, this is not in itself dangerous. But it shouldn’t be ignored, either, and there are treatments available that can help the body return to its normal state.
How is pelvic organ prolapse treated?
Depending on the type of prolapse and its severity, there are several routes for treatment:
- Removal of the organ. Sometimes, the best solution for a prolapsed uterus, for example, is simply a hysterectomy. Though it’s not always required, it is often done either to remove the affected organ or to make room in the pelvis to treat the other organs. A hysterectomy can sometimes be done vaginally, rather than abdominally, making it a less invasive surgery.
- Vaginal mesh surgery. In this procedure, a small piece of mesh is placed in the body to treat prolapse or SUI (the procedures are similar but slightly different). The mesh functions like a sling, supporting the bladder and other organs—basically doing the job of the pelvic floor. The procedure is fast—it only takes about 30 minutes—and is generally considered a viable treatment for SUI. But it’s also led to a lot of unpleasant complications, including infections, pain, or even organ perforation, some of which then require another surgery to correct. A couple years ago, the FDA designated mesh for prolapse as a high-risk device. When it’s done well, the surgery can be helpful, but if you’re considering it, make sure to carefully discuss your options with your doctor. The good news is that mesh technology has evolved significantly over the past decade or so and continues to do so. There are also some surgical options available for some severe types of prolapse that don’t require mesh.
- Kegels. If the prolapse is not very severe, simply strengthening the pelvic floor muscles can do a lot of good.
- Pessary. A small ring can be inserted into the vagina to provide additional support for the organs.
What can you expect after treating pelvic organ prolapse?
If you undergo surgery, you can usually expect a one- to two-week recovery period and about 6 to 12 weeks total during which you should avoid lifting anything more than five pounds, avoid sex, and avoid heavy exercise. You may also experience some discomfort and trouble peeing during this time, but this all clears up with time.
Pelvic floor surgery strives to return the pelvic anatomy back to pre-prolapse conditions and is usually successful long-term. But about 5 to 15 percent of prolapse surgeries fail, requiring either a second (usually lesser) surgery or pessary support. In order to prevent a second prolapse, some lifestyle changes may be in order. The pelvic muscles will continue to be delicate, so heavy lifting is generally advised against, as are abdominal exercises like sit-ups, leg raises, the pilates “hundred,” or intense plank exercises. You might also want to avoid squats and running or other high-impact aerobic exercises.
That said, exercise in general is good and recommended. Good exercises to do after pelvic organ prolapse surgery include dumbbell chest presses, rows, hips thrusts with bands, and inclined treadmill walking. Many other exercises can be done with caution. In general, it’s best to ask your doctor what you’re cleared to do, learn appropriate modifications if necessary, and know what sensations to look for to know if something’s not quite right. Many women return to pilates and even running after surgery with their doctor’s approval.
Pelvic organ prolapse is one of those things that people don’t talk about much but that affect more people than you might realize. A good first step to treating it is knowing about it and knowing what signs to look for. If you have experience of your own, drop a comment below.