Pelvic Organ Prolapse (POP): Signs, Symptoms, and Solutions

Pelvic organ prolapse (POP) is a disorder in which one or more of the pelvic organs drop from their normal position. It is caused by injury to the muscles or tissues supporting the pelvic organs. These organs include the vagina, uterus, bladder, urethra, and rectum. Up to 50% of women will develop POP over their lifetime. Some common symptoms include heaviness or pressure in your pelvis, bulging sensation (may be visible) in the vaginal canal, difficulty completely emptying bowels/bladder, pelvic pain, frequent UTIs, pain during sex, and urinary incontinence. Chronic constipation, vaginal births, and going through menopause increases ones risk of having POP. However, there’s a common misconception that only older women get POP but it can frequently occur in women in their 30s and sometimes even in their 20s. While this may be scary to hear how common POP is, the good news is that POP is treatable! You don’t have to live with these symptoms! Treatment can vary from simple lifestyle changes to surgery! If your doctor recommends surgery, you can still benefit greatly from having pelvic floor physical therapy (PT) before/after for better surgical outcomes. Sometimes, providers will send patients to pelvic PT in order to try to resolve symptoms in hopes to avoid surgery. I’ve helped many of my patients avoid surgery via pelvic PT.

Weakened pelvic floor muscles can cause pelvic organs (bladder, uterus, rectum) to shift. There are a few different types of prolapse, indicating which wall of the vaginal canal is most impacted. A cystocele is a bladder prolapse resulting in anterior vaginal wall laxity. A rectocele is a rectal prolapse into the vagina causing posterior wall laxity. A uterine prolapse is the uterus prolapsing, whereas an enterocele is the small intestine prolapsing.

So what causes this to happen? Pregnancy and vaginal childbirth is the biggest factor. Hormonal changes, straining during bowel movements, heavy lifting without proper core activation, and connective tissue disorders such as Ehlers-Danlos Syndrome can contribute to POP.

Pelvic Floor Physical Therapy should be first-line treatment! A well-trained pelvic floor PT can perform a vaginal and/or rectal pelvic floor muscle assessment to identify deficits in power, endurance, coordination, and mobility. Therapists also should assess the diaphragm and rib cage since the pelvic floor is involved greatly in core stability and breathing mechanics. Kegels may not always fix your issue because the pelvic floor actually never works in isolation. This is why a thorough musculoskeletal assessment should be performed. A good PT also knows lifestyle adjustments to make, information on pessary devices, and will know when to refer you for surgical interventions if you are not making gains in therapy.

POP is preventable which is why pelvic floor care during pregnancy and postpartum is so important. Smart exercise choices and proper progressions such as low impact core strengthening should be considered as well for at-risk populations. Avoiding habits such as straining with bowel movements can help reduce likelihood of getting POP. If you or someone you know is dealing with any of the aforementioned symptoms, seek help EARLY! Don’t wait and don’t book a surgery without trying pelvic floor PT first. You will save yourself lots of money and recovery time! The median cost of prolapse surgery in 2018 was $8,958 and still requires 6-12 weeks to recover afterwards. Surgeons will most likely also recommend you do pelvic PT after surgery. On the contrary, if you seek pelvic PT FIRST you would need 6 to 14 visits (depending on the severity of symptoms), and the cost would be 80-90% less!

Curious if this blog is talking about YOU? Take this quick Self-Check Quiz to see if you have POP! Answer YES or NO to the following questions:

1. Do you feel a heaviness or pressure in your pelvis, especially after standing for long periods?

2. Have you noticed a bulging sensation or felt tissue at the opening of your vagina?

3. Do you have difficulty emptying your bladder or bowels completely?

4. Have you experienced unexpected urine leakage (e.g., when coughing, sneezing, or exercising)?

5. Do you feel discomfort or pain during sex?

6. Have you given birth vaginally, gone through menopause, or experienced chronic constipation?

If you answered “YES” to one or more of these questions, you may have some degree of pelvic organ prolapse. While this condition is common, it’s not something you have to live with! Pelvic floor physical therapy can help strengthen and support your pelvic muscles, reduce symptoms, and improve your daily comfort.

Next Step: Consider scheduling a consultation with me—a Pelvic Floor PT to assess your symptoms and create a personalized treatment plan.