POP sounds fun but may cause involuntary crossing of legs when talking about your vagina.
Pelvic organ prolapse, POP for short, is the slip of your pelvic organs out of place – a stressful occurrence if you're symptomatic but way more common than you think.
Newsflash: About 50% of women experience some degree of POP in their lifetime.
"Prolapse usually involves movement of your bladder, bowel or uterus when the muscles, fascia and ligaments that hold them in place lose their integrity," says Glide Physio & Pilates boss Ellie Parnell.
“Not all women will have symptoms or need to seek treatment, however, a prolapsed organ can descend through the pelvis, presenting as a bulge in the vagina.
"While it can feel really uncomfortable, it is also very treatable.”
Prolapse symptoms commonly include:
- A sensation of a bulge, heaviness or dragging in the vagina or rectum
- A visible bulge at the vaginal entrance
- Lower back pain
- Bladder or bowel problems, including difficulty emptying or leakage
- Painful sex
“It’s important to note that there is nothing wrong with the organs, rather it is the supporting structures that need attention,” says Ellie, adding that gravity has a lot to answer for.
"Prolapse symptoms are often worse at the end of the day due to gravity because humans move in an upright position."
Why me? What causes POP?
As discussed in previous blogs, our pelvic organs are supported and suspended by strong myofascial structures, such as the pelvic floor muscles and the uterosacral ligaments. The endopelvic fascia provides support at the front and back of the vaginal walls.
“Over a person’s lifespan these supporting structures can lose their integrity, becoming stretched, loosened or torn,” says Ellie.
“It often happens through stresses and strains of things like pregnancy, childbirth, coughing, heavy-lifting and constipation.
“It can occur gradually over a long time, or it can seemingly happen all of a sudden."
Diagnosis & treatment.
Pelvic health assessments, education, and management strategies can totes work in your favour. Book an initial appointment with a specialist GP, gynaecologist or women’s health physiotherapist if this article has set off some alarms for you.
Clinical assessment.
Prolapse is assessed via a vaginal examination, and is classified in 2 ways:
1. Location of the prolapse.
- Anterior vaginal wall – usually the bladder, or sometimes a loop of small intestine, slips down and bulges into the front wall of the vagina. This can create problems with urine leakage, difficulty emptying the bladder and can lead to urinary tract infections (UTIs) due to the residual urine in the bladder.
- Apical – the top of the vagina descends down; the cervix and uterus for some women, or for women who’ve had a hysterectomy it is referred to as a vaginal vault prolapse.
- Posterior vaginal wall – usually the rectum, or sometimes small intestine, slips down and bulges into the back wall of the vagina. This can cause difficulty emptying the bowels.
2. Degree of pelvic organ descent.
When the woman is asked to bear down, ie strain down into her pelvis, the movement of the vaginal walls is measured. This movement ranges from:
- stage 0: no movement (rare for any woman who’s had a baby)
- stage 1: some movement (often considered normal)
- stage 2: a bulge near the vaginal opening
- stage 3: bulge more than 1 cm out of the vagina
- stage 4: the wall or organ slips completely out of the vagina.
POP not forever.
The good news is that with the correct diagnosis, you can manage and treat pelvic organ prolapse.
Conservative treatment.
1. Supervised pelvic floor muscle training.
Reduces the frequency and severity of symptoms in stage 1-2 and anterior vaginal wall POP (i). It can help delay the need for surgery and prevent prolapse from getting worse (ii). This is checked by a physiotherapist for correct technique, and regularly monitored either individually or in a group class setting. PFMT is not as effective for posterior vaginal wall (rectal) prolapse, or once the prolapse has progressed to stage 3-4.
2. Lifestyle advice and symptom management.
Positioning, devices and support for effective bladder and bowel emptying, and advice on managing painful sex and/or exercise concerns.
3. Pessaries.
These support the vaginal walls and pelvic organs that lie behind them. Evidence shows pessaries provide greater reduction of prolapse symptoms than PFMT alone. Even in the case of stage 3 and 4 POP (iii), pessaries are recommended as “first-line treatment” for non-surgical management (iv).
Pessaries are prescribed and fitted by a gynaecologist or specially trained women’s health physiotherapist. The appropriate type selected will depend on each individual’s prolapse presentation; some can stay inside for extended periods of time, while others need to be removed daily.
Surgical options.
If conservative measures are unsuccessful in the long term, gynaecologists offer surgical options using stitches or mesh to help hold up the uterus and/or vagina, or to reinforce the vaginal walls. They also commonly offer a hysterectomy to treat uterine prolapse.
Get on top of your Pelvic Health.
Book an appointment with Ellie Parnell, founder of Glide Physio & Pilates, women’s health physio and all-round top human.
Her clinical pilates and physiotherapy rooms are located at Aleenta Health Club, 421 Magill Rd, St Morris.
References.
(i) Wang, T., et al. (2022). The effect of pelvic floor muscle training for women with pelvic organ prolapse: a meta-analysis. Int Urogynecol J. 2022 Jul;33(7):1789-1801. doi: 10.1007/s00192-022-05139-z.
(ii) 6th ICI. (2016, September). 6th International Consultation on Incontinence, Tokyo.
(iii) Zeiger, BB., et al. (2022). Vaginal pessary in advanced pelvic organ prolapse: impact on quality of life. Int Urogynecol. J. 2022 Jul;33(7):2013-2020. doi: 10.1007.s00192-021-05002-7.
(iv) By the American Urogynecologic Society (AUGS) and the Society of Urogynecologic Nurses and Associates (SUNA) Consensus Statement 2023. doi: 10.1097/SPV.0000000000001293.
Previous Pelvic Health blogs:
Pelvic Health: Anatomy & Physiology
