In this article you’ll find updated information about pelvic organ prolapse, its causes, symptoms and treatment. So that you can find the help best suited to your needs.
Around 50% of all women will experience pelvic organ prolapse of some type throughout the course of their lives. About 10% of all women will go through surgery as part of their treatment. Despite these high rates, women all over the world still find themselves misdiagnosed. Many are met with little knowledge and support from their health care provider.
Pelvic organ prolapse is when the walls and/or organs loose elasticity and stability and falls into the vaginal canal. There are six types of pelvic organ prolapse and each one can be diagnosed in terms of severity. In many countries they are graded on a scale from 1 to 4. One means that the prolapse is at the top of the vagina and barely noticeable. Four is when the prolapse is outside the vagina, also when you lying down.
In some countries prolapse is graded from moderate to severe. Since this is a more subjective grading it can lead to the same person receiving varying diagnoses.
It is uncommon to experience only one type of prolapse while all the other pelvic floor structures are intact. Most women experience one type of prolapse as being more noticeable or symptomatic than the others.
The 6 types of pelvic organ prolapse:
- Bladder prolapse (cystocele) – the front vaginal wall descends into the vagina. The bladder often descends as well when this happens.
- Urethra prolapse (urethracele) – not so commonly diagnosed as the bladder and urethra often prolapse together.
- Uterine prolapse (uterocele) – the ligaments supporting the uterus are stretched and the uterus comes down into the vagina. You can often see or feel the cervix.
- Rectal prolapse (rectocele) – the back vaginal wall falls into the vagina. The rectum often descends as well when this happens.
- Anal prolapse (also called rectal prolapse) – the rectum comes out of the anal opening. Either when there is an increase in pressure, such as during a bowel movement, or constantly.
- Small intestine prolapse (enterocele) – then a part of the small intestine falls into the vagina. Very uncommon and can only be definitively diagnosed through surgery.
What are the symptoms of pelvic organ prolapse and how do I know if I have it?
Symptoms of pelvic organ prolapse vary depending on the severity of the prolapse, tension in the muscles around and how sensitive you are in that area. They can also be affected by hormonal changes in the body. Two people with the same diagnosis can experience very different symptoms and issues. That is why treatment and rehabilitation that is holistic and symtpom-specific is so important, not just the diagnosis.
Common for all types of pelvic organ prolapse is a feeling of pressure or heaviness in the pelvic floor, or a feeling of something “falling out of the vagina”. Some experience a sensation of air bubbles in the vagina, a feeling of having a ball/tampon that is “out of place” on the vagina, chafing/soreness around the vaginal opening, or a feeling of something bulging in the pelvic floor/vagina. In severe cases it can feel like a need to push (like when giving birth or having a bowel movement) or a heaviness that feels like a weight in the pelvic floor, and that is only relieved by sitting or lying down.
Common symptoms of pelvic organ prolapse, by prolapse type:
- Bladder prolapse (cystocele): Difficult emptying the bladder. Leaking pee/incontinence after having been to the toilet or with loading/pressure/movement. Persisting urge to urinate, recurring UTI’s, pain during intercourse.
- Urethra prolapse (urethracele): Difficult emptying the bladder. Urge to urinate even right after having been to the toilet. Feels like you’re leaking – even when you’re not. Leaks that are not triggered by pressure/load, recurring UTI’s.
- Uterine prolapse (uterocele): Something bulging/moving in the vagina, especially noticeable when sneezing/jumping/running. A feeling of hitting a wall/obstacle when inserting a tampon/menstrual cup. Pain/discomfort during intercourse/penetration, especially when going deeper into the vaginal canal.
- Rectal prolapse (rectocele): A feeling of something pressing/bulging into the vagina when needing to have a bowel movement. The need to press against the perineum or inside the vagina to empty the stool completely. Never getting completely clean after having a bowl movement – even after a lot of wiping.
- Anal prolapse (also called rectal prolapse): Cracks/small tears when having a bowel movement, “like pooping glass”. Feeling like the stool goes back in when trying to have a bowel movement. Difficulty with wiping after a bowel movement (there is always something left). A feeling of something being pushed out of the rectum when passing stool/having a bowel movement.
- Small intestine prolapse (enterocele): Varying, most often women experience acute pain in the lower part of the abdomen in a particular area of the digestive process.
What does pelvic organ prolapse look like?
What pelvic organ prolapse looks like depends on:
- how severe it is (see the description of grading a prolapse higher up)
- where in your cycle you are (hormonal changes influences the tissue’s elasticity
- what time of the day it is
- how much loading/weight bearing you’ve done since the last time you laid down/slept
- if you’ve been to the toilet (both a full bladder and rectum could make the prolapse more visible)
- how many organs that have prolapsed. If you have prolapses at the same level or if one of them is more severe, one of the other prolapses can be hidden during a visual examination
The images below are meant to illustrate, not to be used for self diagnosis.
Many find it confusing and hard to understand pelvic organ prolapse from anatomical drawings. Which is why we think it’s helpful to illustrate what’s happening in a visual way. Remember that most people experience a combination of these issues. Usually one or two of them are more visible than the rest.
We recommend that you measure progress by judging symptoms. When checking yourself in the mirror it can be difficult to see the progress and difference of a half inch or two, but this can make a huge difference in your symptoms. Which is why we are more interested in symptoms when rehabilitating with hypopressive exercises.
Why does pelvic organ prolapse happen?
The few studies we have on the causes of POP show some common features among the women who experience symptomatic pelvic organ prolapse.
Often it’s either birth, menopause or an injury that gets blamed for the prolapse. This is rarely the only cause, and often merely a catalyst that reveals underlying factors/weakness that have built up over a much longer time.
The biggest factors that make women more prone to symptomatic pelvic organ prolapse are:
- a history of digestive issues (IBS, Chron’s, Ulcerative Colitis, etc) that has lead to too much pushing when having a bowel movement, and where the pain often leads to increased pressure in the abdomen and pelvis
- compression/over-training (hard physical labour/workouts without the right form/support and without proper function in the core and pelvic floor)
- previous core and pelvic floor injuries (hernia, prolapse, leaks, pains, blockages)
- hypermobility/Elher Danlos Syndrome (where the body’s own ability to build/rebuild connective tissue is impaired)
Can you heal pelvic organ prolapse?
In very many cases the answer is YES! Hypopressive exercises are very effective, especially when it comes to treating the pain and symptoms related to pelvic organ prolapse. In most cases, we are able to reverse up to 1,5 to 2 grades of most types of prolapse. Which means that most women can become symptom-free after a rehabilitation period. And that means that most of these women can avoid surgery. Having a strong and functional core and pelvic floor also prevents relapse/worsening of the symptoms later in life.
If you have more advanced/severe pelvic organ prolapse, rehabilitating with hypopressive exercises can make surgery much less extensive. Hypopressive exercises and The Reset program help to restore proper function in the core and pelvic floor. This supports the long-term success of surgery as well.
Would you like to heal from prolapse?
Is surgery the only cure for pelvic organ prolapse?
NO! With proper hypopressive excersise and follow up, you can reverse most types of pelvic organ prolapse up to 1,5-2 grades. This means that those with moderate cases (up to grade 2-3) can become symptom-free.
If the prolapse is very advanced and the tissue very damaged (grade 4), the training can help reduce the prolapse. And make a surgery less extensive and last better.
It is important to know that surgery can never fix the underlying causes of pelvic organ prolapse. Surgery will only “fix” the tissue, it does nothing to restore proper function to the core or pelvic floor. The pelvic floor will still be prone to injury if it is not rehabilitated with the right techniques. This is one of the biggest contributing factors to why many women experience failed surgeries. Or go through surgery for one type of pelvic organ prolapse just to find themselves developing another type later on. Surgery is not a “quick fix” and it comes with risks. We recommend exercise and rehabilitation first to see how much progress can be made before considering surgery. It’s never too late to start hypopressive exercise, not even if you have already gone through an unsuccessful surgery.
Can a pessary help with pelvic organ prolapse?
A pessary is a soft rubber ring that comes in different sizes and shapes. You insert it into the vagina. The pessary can help support the vaginal walls and the uterus. Pessaries does not reverse a prolapse or give you your core function back. It can however relieve symptoms while you’re rehabilitating your prolapse.
Pessaries aren’t for everyone. Even with the different types and sizes it can be hard to find a good fit. Your gynecologist, doctor or midwife can help you find the right size and fit. In most cases you will be able to remove the pessary yourself after this initial fitting. Think of pessaries as a tool, not a solution. It can be helpful if the symptoms lead to too much of a psychological strain, which is very common. The danger with pessary use is that it’s a lot easier to overdo it in terms of loading and activity, because you’re not feeling the symptoms. This can make rehabilitation more difficult and lengthy.
Pessary use is individual, and a lot less risky than surgery. This means it can be a good alternative, as well as give much needed support while rehabilitating.
My gynecologist said “everything looks fine”, but my vagina does not feel right. Why?
Unfortunately many women experience this around the world. It happens because of several things. Before we get into it, it’s important to stress that YOU know your body best. If you feel something isn’t right, you have the right to get help and support from someone who takes your issues seriously.
A vaginal examination is the foundation for diagnosing pelvic organ prolapse. There are some challenges with this. Some women are told that it “looks fine” even tough they experience have pain, discomfort or other symptoms.
- gynecological/vaginal examinations are done lying down – this means that the prolapses are pulled back into the vagina by gravity. Even if you’re asked to cough/push, it will be difficult to examine the grade of prolapse without a standing examination
- health care professionals diagnose based on what might be common and what should be considered for surgery. It is relatively “common” to experience pelvic organ prolapse after birth or during menopause, especially a minor grade of prolapse. And even though it’s not life-threatening or severe, it can significantly affect your quality of life and self-esteem. Unfortunately the health care system lacks effective techniques to resolve/reverse lesser grades of prolapse (like hypopressive exercise). The suggestion is often to wait until it gets better or worse. And if gets worse to attempt to solve it with surgery.
- when you’re examined shortly after birth, it’s hard to determine to what degree symptoms will heal during postpartum. Which is why many women are told to wait and see. We think it’s perfectly fine to wait and see and have plan for rehabilitation at the same time. Having a plan can give you security and a sense of calm. Instead of living with issues while wondering if they’ll ever get better
- women’s health is unfortunately under-researched and under-funded in so many ways. It’s the woman’s job to demand the treatment and support they need. We still have a long way to go in this regard. There also no consensus as to what is “within normal” and what is “severe”. Many suffer from issues they are told are “possible to live with”, without getting sufficient help to resolve them. This is a taboo subject and many women suffer in silence. That is tragic, everyone deserves a life filled with joy and joyful movement! We are on a mission to change this, one step at a time.
Would you like to heal from prolapse?
Would you like to read more about pelvic organ prolapse and hypopressive exercise?
Check out what hypopressive exercise is to understand how it affects pelvic organ prolapse.
National Libary of Medicine has an interesting study you can look into. Read their sudy on hypopressive exercise to rehabilitate the pelvic floor after birth
They have also written more about pelvic organ prolapse and hypopressive exercise here.
Use the information on this page to learn more, not as a tool to self diagnose. If you suspect something isn’t right, seek a qualified and specialized therapist 🙂