How do I know if I have prolapse?

Pelvic Health

Dec 11

Prolapse can sound like a scary thing. But it is extremely common (especially if you have ever been pregnant before). It is not talked about often due to the shame many of us feel talking about what is going on “down there”. It is important to know what prolapse is, and what the treatment options are.

What is pelvic organ prolapse?

Pelvic organ prolapse (POP) is when the organs of the pelvis begin to descend from where they should be. This can happen for a variety of reasons. There are a few different types of pelvic organ prolapse and there are also different stages.

Types of pelvic organ prolapse (POP):

Cystocele - bladder falling back into the vagina
Rectocele- rectum falling anteriorly (or forward) into the vagina
Uterine prolapse - uterus transcending down into the vagina

If you are reading this because you are worried your pelvic organs are falling out of your body, please don’t worry. This is an extremely common thing that happens to many women who have ever delivered a baby.

Stages of Prolapse

Stage 1: the organ has started to fall into the upper portion of the vaginal cavity
Stage 2: the organ has fallen fully into the vaginal cavity closer to the opening of the vagina
Stage 3: the organ has started to move outside of the body
Stage 4: the organ has moved completely outside of the body

Stage 3 & 4 are less common, but certainly happens to many people. It is more common to see Stage 1 & 2 and are often the people reporting pelvic floor heaviness or pelvic floor pressure.

Common symptoms of pelvic organ prolapse

Feeling heaviness in your pelvic floor
Feeling like you have a tampon in when you don’t
Feel like you are sitting on a ball
Urinary symptoms: urinary frequency (going more often), urinary incontinence (leaking), feeling of incomplete emptying of bladder
Bowel symptoms: feel like you need strain to pass a bowel movement, feel like you are unable to empty completely

While this is something that is common among many women, it is not something we should accept as the way it is. There are conservative and surgical solutions, and there are things that can be done to prevent it from getting worse.

If you have reason to believe you may be experiencing pelvic organ prolapse, it is important to have a conversation with your GYN and/or your pelvic floor physical therapist. This is the only way to truly know if this is what you are experiencing, and to help you determine the best next steps.

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Things That Make Pelvic Organ Prolapse Worse

Straining during a bowel movement

Performing “Kegels” (pelvic floor contractions) incorrectly
Lifting heavy with poor pressure management strategies (that lead to bearing down)

Things That Help Pelvic Organ Prolapse

Releasing tension in surrounding areas of the body- this may sound contradictory, but this is what I find helps my patients more than anything. Stop gripping your abs and pelvic floor in attempt to hold your organs up. Release the tension in your body, and there will be less pressure placed down on your organs.
Performing a pelvic floor contraction correctly- it is important to think about drawing up and in when you are performing a “kegel” rather than just squeezing the pelvic floor (which tends to push down on the organs)
Pessaries: these are custom devices that you can be fit for that help give the vaginal wall more support, and therefore preventing the organs from falling down. This can help a lot of my patients with different bladder or bowel symptoms (and it doesn’t involve sugury)
Surgery: slings and other surgical options can be peformed to physically hold your organs back in place

It is strongly encouraged that you start with pelvic floor physical therapy so you are doing the exercises correclty. If you get surgery, but never changed anything about how you manage pressure (and still bear down often) then you may be causing harm to your surgical correction