Pelvic organ prolapse (POP) occurs in as many as 40% of women, most commonly after age 40. One of the most common first symptoms is a bulge protruding from the vagina. Typically one’s first reaction to this is terror, but don’t worry, there is no need for panic.
POP is the result of a laxity of muscles, ligaments and connective tissues that support organs such as the uterus, bladder and rectum. POP, therefore, can be the result of one or several organs, all of which may or may not cause symptoms. The most common symptom is that of a bulge coming out of the vagina, which can rub against the underwear and cause irritation and bleeding. Other organ specific symptoms include:
- The uterus: The uterus is normally supported by the utero-sacral ligaments as well as other connective tissues. A prolapsing uterus often can feel like one is sitting on a lump.
- The bladder: Usually a soft bulge at the top of the vagina. It can be associated with incontinence, difficulty urinating or a pressure sensation.
- The rectum: This is a bulge that comes from the backside of the vagina. It can be associated with difficulty getting a stool out. Commonly, women will describe “splinting” which is putting fingers in the vagina to push the stool out of the rectum.
- The small bowel: This is the least common of the prolapses, and represents a “true hernia” or a fascial defect in the upper vagina. It is most commonly associated with a soft bulge and can happen after hysterectomy as well.
The cause of POP is usually a combination of factors. Genetic predisposition is common. Trauma (most commonly from childbirth, especially large babies) plays a role. Increased strain on pelvic organs is also a common factor. This includes jobs that require heavy lifting, obesity, or smokers, particularly with a chronic cough.
Treatment options range from behavioral modifications or exercises (for mild prolapse) to pessaries to surgery.
A pessary is a device that one places in the vagina and pushes the organs into their normal positions. (On a historical note, the original pessary was a potato, which rapidly fell out of favor as it tended to grow roots. The next rendition of pessaries was yarn dipped in wax and molded. This was the style used for thousands of years until the invention of rubber.) Pessaries come in numerous sizes and shapes. A good pessary is one that a woman doesn’t feel when it is in, stays in place and corrects all of her symptoms.
Surgical correction is specific to the prolapsing organ(s). Surgery is most commonly done entirely through the vagina and requires a one night’s stay in the hospital. Gynecologists are well versed in all treatments for POP and I would encourage anyone with prolapse to discuss it with their gynecologist.