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Pelvic organ prolapse is a condition where one or more pelvic organs (bladder, uterus, rectum, etc) slip down from their normal position and push into the vaginal wall due to weakened and/or stretched pelvic floor muscles and ligaments.

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The pelvic floor muscles act like a "hammock" to support pelvic organs. When these muscles weaken, most commonly due to childbirth, aging, or increased abdominal pressure , they can no longer hold the organs in place. This causes the slipping, falling and misplacement.

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Although this is not usually life-threatening, prolapse can cause discomfort, urinary or bowel problems, and feelings of heaviness and/or pressure. It can significantly impact quality of life if left untreated!

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As women age, especially after menopause, levels of estrogen decrease, which can lead to weaker pelvic tissues. The natural loss of muscle tone and connective tissue strength with age also makes prolapse more likely.

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One of the most common causes pelvic organ proloaspe is vaginal childbirth. During delivery, the pelvic floor muscles and ligaments can stretch and/or tear, weakening the support system that holds pelvic organs in place. Multiple pregnancies or delivering large babies increases this risk. Things that does not increase this risk is non-vaginal childbirth, such as a C-section.

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Activities and/or conditions that increase long-term pressure in the abdomen can strain the pelvic floor. Some examples are obesity, chronic coughing (from conditions like asthma or smoking), frequent heavy lifting, and long-term constipation or straining during bowel movements (commonly from IBS or other bowel illnesses).

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Cystocele occurs when the bladder descends and bulges into the front wall of the vagina because the tissue between them has weakened and/or stretched. It’s the most common type of pelvic organ prolapse and is often associated with strain or damage from childbirth or heavy pressure on the pelvic floor.

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Rectocele - Rectal Prolapse into the Vagina

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Rectocele - Rectal Prolapse into the Vagina

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Rectocele happens when the rectum presses against and pushes into the back wall of the vagina. This occurs due to thinning and weakening of the tissue separating the rectum and vagina, often from repeated strain or age-related weakening of connective tissue.

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Rectocele > Rectal Prolapse into the Vagina

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Uterine prolapse occurs when the uterus slips down into the vaginal canal because the ligaments and muscles holding it in place lose strength. Vaginal vault prolapse refers to the top portion of the vagina dropping downward, which is more common after a hysterectomy.

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People with pelvic organ prolapse often report a sensation of pelvic pressure/heaviness. This especially happens after standing for long periods of time. Some individuals may notice a visible bulge in the vagina, or a feeling that something is “falling out.” These physical sensations are usually the earliest and most recognizable signs of prolapse!

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Beyond physical sensations, pelvic organ prolapse can disrupt normal bodily functions. Many patients experience involuntary loss of urine or stool, frequent urination, or difficulty emptying the bladder completely. Bowel-related issues, such as constipation or the need to apply pressure to the lower stomach to pass stool, may also occur. All of these factors affect both the daily activities of a person and their quality of life.

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Diagnosis usually involves a pelvic examination performed by a healthcare provider while the patient is either lying down or standing. During the exam, the provider evaluates the degree and type of prolapse that is occurring. In certain cases, diagnostic imaging such as ultrasound or an MRI may be used to better understand the extent of organ displacement and plan the best treatment option/s.

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Non-surgical treatment is actually the first option for managing pelvic organ prolapse! Pelvic floor exercises help strengthen muscles that support the pelvic organs and reduce pressure or bulging. Vaginal pessaries (removable support devices) can also relieve discomfort.

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When symptoms are severe, surgery may be required to restore pelvic support. Common procedures include vaginal or abdominal repairs using the patient’s tissue or surgical mesh to reposition their organs. In some cases, sacrocolpopexy or hysterectomy is performed if the uterus or top of vagina is affected. Surgery can relieve pressure, improve function, and restore quality of life. Surgery for this is very risky unfortunately.

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Prevention focuses on protecting and strengthening the pelvic floor before problems develop. Regular pelvic exercises help maintain muscle tone. Yet, other important preventions are managing weight, avoiding constipation and chronic coughing. It's important to practice safe lifting and know postpartum pelvic health education before/after birth. Awareness is everything!!