Female Pelvic Organ Prolapse: Let’s Talk About the Facts
Millions of women are living with the uncomfortable symptoms of pelvic organ prolapse — and far too many are suffering in silence. An estimated 6.6 million women in the United States experience symptoms of female pelvic floor prolapse, though experts believe the true number may be closer to 20 million due to underreporting and the stigma surrounding these issues.
If you’ve been dealing with pelvic pressure, urinary leakage, discomfort, or a feeling that “something just isn’t right,” you are not alone — and you do not have to accept it as a normal part of aging or childbirth.
The good news is that effective treatments are available, and talking with a specialist is the first step toward relief and getting back to living comfortably and confidently.
Pelvic organ prolapse – when one or more of the organs in your pelvis slip through the vagina – is a common, natural process. And it is expected to become more common: The number of U.S. women with pelvic prolapse is projected to rise by nearly 50% by 2050, owing largely to demographic changes.
Being common and natural doesn’t mean you have to live with it, yet few women with pelvic prolapse speak of their symptoms. This is due as much to lack of understanding as to embarrassment. But pelvic floor prolapse needs to be discussed in order to be treated, and it can be treated in a number of ways.
In fact, researchers are continually developing innovations in pelvic prolapse procedures. Let’s talk about it here.
Causes, Risks, and Symptoms of Modern Pelvic Prolapse
Your pelvic floor contains a network of muscles, ligaments, and tissues that serve as a living hammock, holding your bladder, urethra, uterus, upper vagina, and rectum in place.
Over a woman’s life span, a series of natural events can occur that will weaken this network, including pregnancy, menopausal hormone changes, and simply age. If the pelvic floor becomes too weak or endures too much pressure, it will have trouble supporting the organs, enabling them to shift out of place, slip into the vagina, and potentially bulge out.
In addition to the above natural events, risk factors and causes for pelvic prolapse include:
High body weight. Research finds people who are overweight have higher chances of developing pelvic prolapse than those within a weight range considered healthy for their body types.
Persistent abdominal pressure. Chronic constipation or coughing (such as from asthma or smoking) and repeated lifting add pressure that can in time wear down pelvic floor muscles.
Your genetics. Studies find it is possible to inherit pelvic organ prolapse. For example, some women are born with weak or loose connective tissue (Marfan syndrome), making them more prone to prolapse.
The telltale signs of pelvic prolapse include:
- A sense of pressure in the pelvis and/or vagina
- Feeling or seeing a bulge of tissue from your vagina
- Lower pelvic or back pain
- Painful intercourse
- Frequent and urgent need to pee (in cases when the bladder slips)
- Trouble moving your bowel or urinating
- Repeated urinary tract infections from urine retention
What to Expect if You Have Pelvic Prolapse Symptoms
Should you experience a combination of the above symptoms, it is likely time to seek a referral to a urology specialist. Prepare to undergo an exam of your abdomen and vaginal area, as well as to answer questions about your family medical history.
Your doctor might perform a series of diagnostic tests, most often one or more urinary tests (such as voiding and urodynamic tests to gauge bladder function) and/or an internal exam of your pelvis using an image-transmitting scope (cystoscopy).
If your physician diagnoses pelvic organ prolapse, your treatment options will depend on its severity, but also what works best for your lifestyle. For example, you might be advised to start with one of these more conservative approaches:
Treatment options for prolapse – non-surgical
Kegel exercises – These core-muscle squeezes, when performed daily, are proven to strengthen the pelvic floor over time. Simply imagine you have to urinate, then squeeze your pelvic muscles for several seconds as if you’re holding it in. Repeat 10 to 20 times a day, sitting or lying down.
Pessaries – A treatment that involves a small, silicone devise inserted into the upper vagina to support shifting organs and tissue. Your medical team will work with you to determine the type and size of pessary suited for you, so expect to undergo at least one fitting.
Lifestyle modifications – With this method, you avoid activities that strain the pelvic floor such as heavy lifting and straining, reduce pressure-related constipation and asthma through medications or other means, and lose weight.
Treatment options for prolapse – surgical interventions
There is no one-size-fits-all approach to treating pelvic organ prolapse, which is why it’s important to work with a specialist to find the option that best fits your symptoms, anatomy, lifestyle, and goals. In many cases, surgery can provide lasting relief and improve quality of life. The most common surgical options for pelvic organ prolapse are:
Reconstructive surgery (abdominal) – A surgeon can rebuild your pelvic floor, from the abdomen to the tailbone, by stitching in a synthetic mesh. This procedure, called a sacrocolpopexy, can be performed robotically through a small incision in the lower abdomen.
Reconstructive surgery (transvaginal) – Similar to above, a surgeon can rebuild your pelvic floor, but this time going in vaginally and using a graft made of living tissue (including your own). Learn more about female pelvic reconstructive surgery here.
Altering the vaginal opening – Referred to as “obliterative” surgery, this approach can either narrow the opening of the vagina or shorten the vagina. Either procedure is designed to prevent organs from slipping into the vagina, but might eliminate your ability to have intercourse. (It will not affect your ability to urinate normally.)
Each option has unique benefits, and a urologist or urogynecologic specialist can help determine the right treatment plan for you.
You Don’t Have to Silently Live with Pelvic Prolapse
If half of all women succumb to gravity at some point and experience the symptoms of pelvic organ prolapse, then you likely know someone who has it. It might be you. If so, take notes of your symptoms and talk to your doctor about it.
Want to know more? Read more about pelvic organ prolapse and request an appointment