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Pelvic Organ Prolapse

Please see the drop down menu for the different prolapse types

According to some clinical evidence, pelvic organ prolapse will affect 50% of the female population at some time during their lives. However, only around  6.5% are become symptomatic. 

Many women find that they have a prolapse only when they go for their internal examination. 

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There are several types of prolapses and which women may experience one or several at the same time. It is a debilitating and embarrassing condition which millions of women face daily.

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Pelvic organ prolapse is where the fascia and pelvic floor muscles no longer support the internal organs, which lead to the organs descending into the vaginal walls.  (hernia) 

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What are the different types of prolapses?

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What are the different grades of prolapse?

Pelvic organ prolapses are graded on the measurement in cm of where they drop down. 

  • Grade 1 is a slight prolapse

  • Grade 2 is slight to moderate prolapse

  • Grade 3 is a moderate to sever prolapse

  • Grade 4 is a severe prolapse otherwise known as a procidentia where the organ is completely everted out of the vagina. 

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Understanding Pelvic Organ Prolapse (POP)

1. POP is Complex & Multifactorial (It Has MANY Causes):

 

  • No single cause: It results from a mix of genetics, childbirth, aging, hormones (like menopause), lifestyle (obesity, heavy lifting), and tissue strength.

 

  • Childbirth is a major factor: Vaginal delivery can weaken pelvic muscles/nerves (20% of first-time moms show muscle damage on MRI).

 

  • Other risks: Family history (2-3x higher risk if mom/sister has it), connective tissue disorders (e.g., Ehlers-Danlos), chronic constipation, and simply getting older.

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2. POP is Very Common, But Symptoms Vary WIDELY:

 

  • Lifetime risk is high (30-50%), but symptomatic POP is lower (3-12%).

 

  • Many women have mild prolapse (Stage 1) without knowing it – it might even be considered "normal" support variation.

 

  • Symptoms often don't start until the prolapse reaches the vaginal opening.

 

  • Location matters: Anterior (front wall/bladder) prolapse is most common. Apical (top of vagina/uterus) prolapse is often missed but usually present with significant front/back wall prolapse.

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3. POP Often Comes with Other Problems (Comorbidities):

 

  • Urinary Issues: Very common! Includes stress incontinence (leaking with cough/sneeze), urge incontinence (sudden strong need to go), difficulty emptying, and nocturia (waking up to pee). Surgery can help these, but sometimes causes new incontinence.

 

  • Bowel Issues: Faecal incontinence, constipation, feeling of incomplete emptying can occur due to the prolapse disrupting normal function. Surgery can help these too.

 

  • Sexual Function & Body Image: This is complex and personal. POP can cause pain, reduced desire, or avoidance of sex due to symptoms or feeling self-conscious. Crucially, research shows a woman's perception of her body image strongly influences her sexual function more than the actual stage/type of prolapse. Treatment (including physio or surgery) often improves body image and sexual satisfaction.

 

  • Pelvic Pain: Discomfort, pressure, or pain (including during sex) is frequently reported.

 

4. Evaluation is Detailed & Tailored - There's No Single Test:

 

  • History is Key: Doctors need a detailed discussion about ALL symptoms (bulge, bladder, bowel, sex, pain).

 

  • Physical Exam is Essential: This includes a speculum exam to see and measure the prolapse.

 

  • Staging Systems (POP-Q/S-POP-Q): These are specific measurement tools doctors use to describe how far down organs have moved. They are reliable and important for tracking changes and planning treatment.

 

  • Imaging (Ultrasound/MRI): Useful in some cases, especially to see muscle damage, check for hidden problems (like enterocele), or after previous surgery. Ultrasound is becoming an important predictor tool.

 

  • Testing for Hidden Problems: If prolapse is severe, doctors check for things like hidden stress incontinence (by reducing the prolapse and asking you to cough) or kidney issues.

 

  • Conclusion: Evaluation must look at the whole picture - the anatomy, the symptoms, and how it's affecting your life and function.

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5. Treatment MUST Be Individualized:

 

  • The paper emphasizes a "tailored and holistic approach". This means treatment should address BOTH the physical support and the specific symptoms bothering you (bladder, bowel, sex, pain).

 

  • Surgery is effective for correcting anatomy and often significantly improves related problems (incontinence, bowel issues, pain, body image, sex). However, it has risks and costs:

 

  • It's expensive (US costs in the billions).

  • Can cause new stress incontinence in women who didn't have it before (13-65%!).

 

  • Doesn't always prevent future prolapse.

 

  • Physio's Role is Implied & Supported by the Complexity:

 

  • Because POP has so many contributing factors (muscle weakness, lifestyle, tissue integrity), addressing these factors is fundamental. This is where physio shines (strengthening muscles, improving coordination, education on bowel/bladder habits, managing constipation, advising on lifting/modifying activities).

 

  • Because symptoms vary wildly and mild prolapse is common, not everyone needs surgery.

  • Physio is the first-line, conservative management recommended globally for symptomatic POP, especially for mild-moderate cases or for those who want to avoid/wait for surgery.

 

  • Because body image and function are crucial, physio helps women understand their bodies, regain control, improve symptoms, and feel more confident, which directly impacts quality of life and sexual function.

 

  • Pre-surgery physio is often vital to optimize pelvic floor function for better surgical outcomes.

 

  • Post-surgery physio is essential for recovery and maintaining results.

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Is surgery the only solution?  

No! Surgery should be the last resolution, and even then surgery isn't always successful. 

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Restore Your Core is a proven program to reduce prolapses. 

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Conservative management should be the first course of action. A women's health physiotherapist who specialises in pelvic organ prolapse is a good place to start. 

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What methods are used?

There are several options for you if you have a prolapse and this will depend on several factors. 

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Pessaries

A pessary is a medical device which can be self managed or left in the body for a number of months and removed by your practitioner who has had the necessary training. 

Pessaries come in all different shapes and sizes. Usually a your practitioner will start off with a ring pessary as this will give a good idea of your size and if your body will support a pessary. 

Sometimes it can take up to 10 visits of trying different sizes and shapes before you find the right pessary. Don't give up. 

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Pessaries are made from various materials, PVC, silicone, latex, galvanised rubber.

They are not a permanent fixture, but more like a quality of life support tool. 

They will support the descending organs but pessaries are not there to reduce or improve the actual size, they are there to improve the symptoms. 

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Exercises

Your physiotherapist can advise you on the best exercises to improve your core muscles. Remember it isn't just about strengthening the core, it's about improving the surrounding muscles also. Pfilates is a clinically proven method to improve overall muscle condition and reduce incontinence and pelvic organ prolapses. 

Remember that if you do have surgery, exercises will have to be an ongoing integral part of your life to maintain good pelvic floor control. 

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Support undergarments

There are several excellent support garments available specifically designed for pelvic organ prolapse. They can be worn at any time offering good support and comfort.

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