Pelvic Organ Prolapse refers to the bulging or dropping of one or more of the pelvic organs from their normal position into or out of the vagina. The pelvic organs consist of the uterus, vagina, bowel and bladder. These organs are held in place by the pelvic floor, ligaments and fascia (a network of supporting tissue). Pelvic organ prolapse occurs when these muscles, ligaments and fascia that hold these organs in their correct positions become weakened or damaged.
Up to 75% of women will develop some form of prolapse in their lifetime
What can cause POP?
The main cause of POP is pregnancy and Vaginal delivery, particularly a vaginal birth involving a long pushing stage or forceps, but other things that can also cause POP include:
- Ageing and menopause
- Chronic coughing
- Being overweight/obese
- Chronic constipation
- Heavy lifting
Symptoms can include:
- A heavy dragging feeling in the vagina or lower back
- Feeling of a lump in the vagina or outside the vagina
- Urinary symptoms such as slow urinary stream, a feeling of incomplete bladder emptying, urinary frequency or urgent desire to pass urine, and urinary stress incontinence
- Bowel symptoms, such as difficulty moving the bowel or a feeling of not emptying properly, or needing to press on the vaginal wall or rectum to empty the bowel
- Discomfort during sexual intercourse
Locations and types of prolapse:
A prolapse may arise in the front wall of the vagina (anterior compartment), or back wall of the vagina (posterior compartment), the uterus or top of the vagina (apical compartment). Many women have a prolapse in more than one compartment at the same time.
Anterior Wall Prolapse:
This is when the bladder drops down and pushes the front wall of the vagina downwards. Your care provider may refer to this as a cystocele.
Posterior Wall Prolapse:
This is when the lower part of the large bowel (rectum) bulges into the back wall of the vagina and/or part of the small intestine bulges into the upper part of the back wall of the vagina. Your care provider may refer to this as a rectocele.
This occurs when the uterus (womb) drops or herniates into the vagina. This is the second most common form of prolapse.
How do you stage prolapse?
Prolapse can occur in different stages which range from stage 0, where organs are in the most anatomically correct position, to stage 4 where they are external to the vagina. Most commonly prolapses will be stage 1 -2, and less often will they be stage 3 and 4.
The stages of prolapse are based on the POP-Q system of measurement:
- Stage 0: there is essentially no prolapse demonstrated.
- Stage 1: there is a little bit of downward movement of the pelvic organs, however they are still high in the vagina and you may be asymptomatic.
- Stage 2: one or more of the pelvic organs has descended and may be just inside the entrance of the vagina. You may be able to feel this, or you may be asymptomatic. Up to 47% of women will have a stage 2 prolapse.
- Stage 3: one or more of the pelvic organs has descended past the entrance of the vagina. You may feel or see a bulge at the entrance of the vagina and you may have symptoms of heaviness and urinary and bowel dysfunction.
- Stage 4: one or more of the pelvic organs are >2cm outside the vagina. This stage of prolapse is rare.
While this may seem scary, a lot of prolapses can become asymptotic and having a pelvic organ prolapse does not mean it will affect your everyday life forever.
You can read about treatment options here.