What Is Pelvic Organ Prolapse?

Pelvic organ prolapse is a pelvic floor disorder (PFD) that occurs when the muscles surrounding the rectum, bladder, and uterus weaken and pelvic organs drop into the vagina. Pregnancy and childbirth may increase risk, as well as obesity, heavy lifting, and coughing, as these too, put pressure on the pelvic floor muscles.

According to Gina Cunningham, DPT, a pelvic floor physical therapist at Axia Women’s Health, pelvic organ prolapse is caused by a weakening of the pelvic floor muscles. "Most often, pelvic organ prolapse can occur as a result of childbirth when there is trauma to the muscles causing them to weaken," Cunningham told Mom.com.

"Another cause could be repetitive valsalva, which is when one holds their breath and bears down. This can occur with straining constipation, repetitive heavy lifting, or chronic coughing conditions such as COPD or asthma. The weakened pelvic floor cannot exceed pressure forces causing the organs to descend," Cunningham added.

Pelvic organ prolapse can also occur as women age and during menopause, but of course, genetics can also play a part; core strength and bone density can affect the strength of connective tissues. There's no real way to prevent pelvic organ prolapse, but adhering to a healthful diet, maintaining your weight, smoking cessation, and regularly engaging in pelvic floor exercises can reduce risk.

Cunningham suggests that pregnant women begin pelvic floor exercises in the second and third trimesters to help prepare muscles for childbirth. "The stronger and healthier your muscles can be going into pregnancy, the better chance you may have at recovering postpartum," Cunningham advised.

The most common symptoms of prolapse include a feeling of heaviness in the pelvic area. Lower back pain may be a factor, as well as discomfort when having sex. Problems urinating or issues with tampons pushing back out could also be indicators.

When Kim Vopni was pregnant with her first child, she became passionate about educating others on pelvic health. She had stage 2 uterine prolapse that she was able to reverse, and underwent surgery after living with a stage 2 rectocele prolapse for nine years. Vopni uses props to help patients understand exactly what pelvic organ prolapse is and how to recognize it, as indicated in her informative videos.

"The best thing a woman can do to prevent prolapse (and any pelvic floor dysfunction for that matter) is to see a pelvic floor physiotherapist, ideally prior to conception, then during pregnancy, then at six weeks postpartum, and then annually," the mom of two explained on Vaginacoach.com.

Your healthcare provider may be able to diagnose you by reviewing your medical history and performing a pelvic exam. An ultrasound can determine the degree of prolapse. Urine tests (urodynamics) can also be effective in diagnosing pelvic organ prolapse in cases where incontinence is a concern. Your doctor may also suggest an MRI or a cystoscopy, which uses an endoscope to assist your doctor in viewing the inside of the bladder.

While Kegel exercises are the most common therapy prescribed for strengthening the pelvic floor, Cunningham reminds her clients that proper form is key. "I work closely with my patients to teach them the proper way to do a Kegel and also work with them on other exercises like breathwork and abdominal work to ensure all of the muscles are working together," she told Mom.com. "Pelvic floor therapy isn't just about strength, it's also about coordination."

In cases where a patient doesn't respond or improve with pelvic floor physical therapy, a pessary — a device that fits into the vagina to support vaginal tissues — can be inserted. Hormone treatment can also be considered after menopause, and some cases may be reversed through procedures like vaginal mesh surgery, hysterectomy, or surgical repair.