POP is a type of pelvic floor disorder. Muscles and ligaments that comprise the pelvic swing (floor) that supports pelvic organs weaken, and those organs move out of place, or prolapse. About one-third of women experience some degree of prolapse over their lifetimes.
The pelvic floor is a group of muscles, ligaments and tissues that keep pelvic organs in place and creates a sort of sling across the pelvic opening. The pelvic organs involved typically are the bladder, urethra, vagina, small bowel, rectum and uterus. Some women develop pelvic organ prolapse after childbirth, noted as one of the risk factors for POP.
Pelvic organ prolapse refers to the drooping of any of the aforementioned organs. These organs are considered prolapsed if they descend into or outside of the vaginal canal and rectum. Some women can feel the signs of prolapsed; others may not experience symptoms.
Reported symptoms include a low backache, feeling like something is falling out of the vagina, urinary problems, vaginal bleeding, feeling pressure or fullness in the pelvic area, painful intercourse, the chronic urge to use the bathroom, leaking urine, and constipation. Some women have no signs of POP.
Symptoms depend a little on which organ is involved and drooping. With the bladder, urine leakage is typical. Uncomfortable sex and constipation could mean the rectum or uterus is prolapsed. Backaches and uncomfortable sex may mean a small intestine prolapse.
The cause of prolapse may be an increase in abdominal pressure, such as obesity. Other causes include childbirth, pregnancy and labor (the most common cause of POP), chronic coughing because of a respiratory problem, pelvic organ cancers, constipation or a hysterectomy in which the uterus is surgically removed.
Anterior Prolapse
Cystocele, or anterior prolapse, occurs when the bladder prolapses. The bladder bulges into the vagina because the supportive tissue between the woman’s bladder and vaginal wall weakens and stretches. Prolapse causes can include muscle strain, so those who have gone through vaginal childbirth are at risk as are those who have violent coughing fits, constipation or perform heavy lifting.
In mild cases of anterior prolapse, there may be few -- or no -- symptoms. But signs of cystocele include fullness or pressure in vagina or pelvis, the feeling of not completely emptying the bladder after urination, pain or urine leakage during intercourse, repeated bladder infections, and increased discomfort when straining or coughing. In severe cases, tissue may protrude from the vagina.
Some risks include obesity, one or more vaginal births and having a hysterectomy, but also include aging because of the pronounced reduction in estrogen production. Estrogen keeps this region’s connections strong and flexible, and with the advent of menopause, estrogen becomes scarce. And having a genetic predisposition to weaknesses in connective tissues allows an anterior or almost any kind of prolapse to take hold.
One form of treatment is with a supportive device, or pessary, a plastic tube or ring inserted into the vagina to support the bladder. There is also estrogen therapy. Estrogen helps make collagen, a protein that helps support pelvic tissues to stretch and return to shape. The lower the estrogen levels, the lower the collagen levels in the body. This condition is found more often in women with multiple sclerosis, muscular dystrophy and spinal cord injury.
Uterine Prolapse
Pelvic floor muscles and ligaments that hold the uterus in place may begin to weaken and stretch. At this point, the uterus slips down into the vaginal canal or protrudes out of it.
Symptoms of uterine prolapse can include the sensation of heaviness or pulling in the pelvis, lower back pain, trouble having a bowel movement, sensation of looseness of vaginal tissue, urine leak or urine retention, feeling like something is falling out of the vagina or that you are sitting on a small ball, and tissue sticking out of the vagina. Symptoms may worsen throughout the day.
Damage to supportive tissues during pregnancy and childbirth -- and gravity -- are some causes of uterine prolapse. Other possible causes include repeated straining over the years, difficult labor and delivery, loss of muscle tone, delivering a big baby (nine pounds or larger) vaginally, and loss of estrogen.
Risks include frequent heavy lifting, a genetic predisposition to weak connectors, prior pelvic surgery like a hysterectomy, increasing age, straining during bowel movements, being Hispanic or white, chronic coughing, and one or more vaginal births.
Complications may include some of the vaginal lining being displaced by a falling uterus and protruding outside of the body, possibly rubbing on garments. This irritation could become vaginal ulcers with the chance of getting infected.
Small Bowel Prolapse
Enterocele occurs when the small bowel/intestine falls into the pelvic cavity and creates a bulge by pushing against the top of the vagina. A woman can have few to no symptoms. Some symptoms are a pulling sensation in the pelvis that eases while lying down, low back pain that also eases when lying down, pelvic pressure, fullness or pain, vaginal discomfort, painful intercourse, and a bulge of tissue in the vagina.
The causes of small bowel prolapse include pregnancy and childbirth, the most common cause of POP, chronic cough or bronchitis, being overweight or obese, repeated heavy lifting, and straining with bowel movements or constant constipation.
Risk factors include race -- Hispanic or white women seem to be more at risk; obesity, age, increased abdominal pressure such as straining bowel movements and chronic coughing, connective tissue disorders, and a family history of organ prolapse.
Though you may be embarrassed to talk to your physician about prolapsed organs, there are available treatments that can add to your sense of security and comfort. Remember, you aren’t the only woman going through this dilemma.