By Sherrie J. Palm

Pelvic organ prolapse. Pessary. Urogynecology. Terms that all women should be familiar with, terms that few women are. Pelvic organ prolapse is a common female health condition that has probably been around since the beginning of mankind yet sadly remains in the closet. Frankly, women are just too embarrassed to talk about it. We need to change the dynamic. We need to change it now.

There are over 3 million women in the US with pelvic organ prolapse, millions more in countries around the world. Every year hundreds of thousands of women are diagnosed with POP, and countless more suffer silently with symptoms that they can’t make any sense out of; is it a digestive thing, is it a colon cancer thing, is it a female hormone fluctuation thing? When we don’t know what our symptoms mean our minds can be our worst enemies, imagining the most negative scenario.

Half of all women over the age of 50 suffer from at least one of the five types of pelvic organ prolapse; many women in their 20s, 30s and 40s have POP as well. The 5 types of pelvic organ prolapse are cystyocele (bladder), rectocele (large bowel), enterocele (intestines), vaginal vault (vagina caves in on itself after uterus is removed-hysterectomy), and uterine (uterus). When the PC or pelvic floor muscles weaken, one or more of these organ/tissue areas drop down into the pelvic cavity below their normal positions.

Each of these 5 types of POP has its own symptoms, but in general symptoms can include:

  • Pressure, pain, or “fullness” in vagina or rectum or both.
  • Tissues bulging outside of the vagina, may feel like sitting on a ball.
  • Urinary incontinence.Urine retention (you have to pee, you just can’t get it to come out).
  • Fecal incontinence.
  • Constipation.
  • Back/abdominal pain.
  • Can’t keep a tampon in.
  • Pain with intercourse.
  • Lack of sexual sensation.

There are multiple causes of POP; most women have more than one causal factor. The most common causes of POP are:

  • Vaginal childbirth-most common cause-complications from large birth weight babies, extended 2nd  stage labor, forceps & vacuum deliveries, multiple childbirths, improperly repaired episiotomies. (It is also possible for women who have never given birth to have POP; there are many non-childbirth related causes.)
  • Menopause-age related impact to muscle tissue (both internal and external) due to drop in estrogen level; this impacts strength, elasticity, and density of structural tissues.
  • Chronic constipation-IBS (irritable bowel syndrome), poor diet, lack of exercise can all cause constipation.
  • Chronic coughing-smoking, allergies, bronchitis, and emphysema can create chronic coughing.
  • Heavy lifting-repetitive heavy lifting at work, lifting children, weight trainers.
  • Joggers, marathon runners, aggressive athletics-constant downward pounding of internal structures.

  • DRA (Diastatis Rectus Abdominus)-split on long abdominal muscle during pregnancy creates a weakness in core muscle layer.

  • Neuromuscular diseases-MS, Marfan, Ehlers-Danlos Syndrome, hypermobility.

  • Genetics-heredity may predispose women to increased risk factors. 

  • Hysterectomy-tissues must be anchored properly to prevent vaginal vault prolapse. 

 There is hope for women with POP; there are both non-surgical and surgical treatments that can be utilized to control, improve, or repair this health concern. Kegels, pessary, Incostress, exercise programs, biofeedback, electrical stimulus, myofascial release therapy, hormone replacement therapy, support garments, and  tibial nerve stimulation are some of the most commonly utilized nonsurgical treatments; typically women utilize multiple treatments at the same time. The most positive direction we can take is to increase awareness so women start recognizing POP symptoms when they occur. Women who have been diagnosed with POP need to come out of the closet with their diagnosis and treatment paths and share that information with other women, their mothers, their daughters, their sisters, their friends. The sooner we take POP out of the closet, the sooner women will be able to identify it and seek professional diagnosis and treatment. 


March 2012