Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a condition that occurs when the pelvic organs, such as the bladder, uterus or rectum, bulge or drop into the vaginal canal. POP develops because the pelvic floor muscles and ligaments, which attach to the organs and help keep them in place, are weak or damaged. 

This condition is relatively common as women age, especially among women who have given birth, reached menopause (when estrogen levels decline) or strained their pelvic floor muscles or ligaments. But younger women can also develop it. Many women are embarrassed to talk to health care providers about this condition, but POP is treatable.

Types of pelvic organ prolapse

There are four main types of pelvic organ prolapse, and if you have one type, you’re at higher risk of developing another.

Cystocele (bladder prolapse)

Bladder prolapse occurs when the wall between the bladder and the vagina weakens, so the bladder bulges into the vaginal canal. Symptoms of bladder prolapse include: 

• A sensation of a bulge in the vagina
• Frequent urinary tract infections (UTIs)
• Difficulty starting to urinate
• A weak urine stream
• A sensation that your bladder doesn’t empty all the way (urinary retention)
• Having to urinate urgently or often

Rectocele (rectum prolapse)

Rectum prolapse occurs when the rectal wall falls into the back wall of the vagina. Symptoms of rectum prolapse include: 

• A feeling that you haven’t emptied your bowels all the way
• The need to push stool from your rectum manually during bowel movements
• A sensation of a bulge in the vagina

Uterine prolapse

With uterine prolapse, the uterus moves down into the vaginal canal because the pelvic floor is weak. Symptoms of uterine prolapse include:

• Pelvic pain, pressure or heaviness that gets worse with standing, physical activity or at the end of the day 
• A sensation of a bulge in the vagina
• Lower back pain
• Urinary incontinence
• Discomfort or pain during sex
• Decreased sexual sensation
• Difficulty achieving orgasm

Enterocele (small intestine prolapse)

Small intestine prolapse occurs when the small intestine pushes against the vaginal wall, usually due to weak pelvic floor muscles and ligaments. Symptoms of small intestine prolapse include: 

• Pelvic pressure, discomfort or pain
• The feeling that there is a bulge in the vagina
• Difficulty with bowel movements

Pelvic organ prolapse causes and risk factors

Various factors can increase your risk of pelvic organ prolapse:

• Pregnancy and childbirth: Pregnancy and childbirth can stretch and weaken the pelvic floor muscles and ligaments. Pelvic organ prolapse can be more common in women who had multiple pregnancies, difficult deliveries or gave birth to a baby weighing more than 8.5 pounds.
• Aging: As women get older, their pelvic floor muscles and tissues can become weaker, especially after menopause when estrogen levels decline.
• Frequent constipation: Straining during bowel movements can place pressure on the pelvic floor.
• Chronic coughing: Women with conditions that cause a lot of coughing could strain the pelvic floor muscles.
• Heavy lifting without proper technique: It’s important to use proper technique when lifting heavy objects as it can stress these muscles. 
• Genetics: Some people are more likely to develop pelvic organ prolapse based on their family history.
• Certain connective tissue disorders: Disorders like Ehlers-Danlos syndrome can weaken the pelvic floor muscles.
• Pelvic surgery: Surgeries such as hysterectomy can also weaken the pelvic floor.

Preventing pelvic organ prolapse

POP cannot always be prevented, but maintaining a healthy body weight, practicing pelvic floor exercises and having good bowel habits can help. If you have a chronic cough, constipation or urinary incontinence, seek treatment — it may help prevent pelvic organ prolapse from getting worse. 

Talk to your health care provider if you are experiencing symptoms. POP can be managed and treated so your symptoms and your overall well-being improve.

Learn more about diagnosis and treatment of pelvic organ prolapse.