Problems in the Bathroom and Bedroom? It Could Be Pelvic Organ Prolapse

Let’s face it: As we age, body parts shift and don’t always end up sitting where they once were. But if you think all you need to worry about is your breasts, brows or butt, think again.

The shifting doesn’t only happen on the outside. It can happen inside your body too. And changes in your pelvis — the area where your reproductive and digestive organs are — can affect how your body functions in the bathroom and the bedroom.

“Your pelvic floor is a group of muscles that form a bowl to support the pelvic organs above it, including your rectum, vagina and bladder.” says Dr. Raymond Foster, an MU Health Care urogynecologist who specializes in pelvic reconstructive surgery. “When those muscles don’t work or aren’t strong anymore, you lose that support.”

A weak pelvic floor has a domino effect, like the bottom of a bag of groceries straining and then giving out. When your pelvic floor stretches or collapses, one or more of the organs above it can fall out of place — a condition called pelvic organ prolapse (POP).

Here are seven things you need to know about POP:

1. Pelvic Organ Prolapse (POP) Is Common

It’s not uncommon for pelvic floor muscles to weaken over time. According to The American College of Obstetricians and Gynecologists (ACOG), about one in four women will develop POP in their 40s. By the time you reach your 60s, POP affects one in three. About 50% of women in their 80s live with POP.

You’re more likely to develop POP if you are:

• Age 40 or older
• A smoker or have a history of smoking
• Asthmatic
• Genetically inclined (have a family history of POP)
• Overweight or obese
• White or Hispanic

2. Childbirth Isn’t the Only Thing That Weakens Pelvic Floor Muscles

Vaginal childbirth is a primary cause of POP — especially if it includes large babies, prolonged labor, multiple childbirths or an episiotomy (surgical incision to widen the vaginal opening). But even people who never experience childbirth can develop prolapse.

Other common risk factors for POP include:

• Menopause, due to decreased estrogen levels that weaken the pelvic muscles
• Chronic constipation, which can result from irritable bowel syndrome (IBS), poor diet or lack of exercise
• Chronic coughing, often from smoking, lung issues or allergies
• Straining regularly due to heavy lifting

3. Peeing When You Jump or Run Isn’t the Only Prolapse Symptom

In more moderate or severe cases of POP, you may see pink tissue or an entire organ bulging out of your vagina. But prolapse typically affects the inner workings of your pelvic region even before you can see it.

POP can cause feelings of heaviness, fullness or pressure in your pelvis or lower back, as well as:

• Bladder issues: Some of the first signs of prolapse include leaking urine (urinary incontinence) and being unable to empty your bladder.
• Bowel symptoms: When your rectum falls into your vagina, it can worsen constipation, make it hard to push stool out or cause accidental bowel leakage (fecal incontinence).
• Sexual effects: Prolapse may affect your desire to have sex, how sex feels (painful or loss of sensation) or your ability to reach orgasm.

The good news is that only about 12% of women between ages 45 and 85 who have prolapse are symptomatic. But even when symptoms appear, many people don’t realize they stem from POP.

“When you start having trouble with any of the three functional areas of your pelvis, you should seek care,” Dr. Foster says. It’s best to treat the symptoms before they affect your mental and physical well-being.

4. Pelvic Organ Prolapse Symptoms Can Be Progressive

Not all prolapse is the same. A urogynecologist can assess the extent of your condition.

“We do an exam called pelvic organ prolapse quantification (POP-Q),” Dr. Foster says. “It’s a series of nine measurements. We look at those measurements to stage prolapse.”

The stages range from one (mild symptoms) to four (severe symptoms):

• Stage 1: Prolapse is mild, and your pelvic floor is still supporting your organs.
• Stage 2: Your pelvic organs have fallen into the lower part of your vagina.
• Stage 3: Your organs are coming out of your vaginal opening.
• Stage 4: Your pelvic organs have slipped entirely out of your vagina.

Over time, prolapse may progress from one stage to the next, but not necessarily. It depends on your overall health and how you reduce your risk factors.

“I can tell you that it's not going to get any better on its own, but we don’t know for sure it will get worse,” Dr. Foster says. “The reason is because prolapse depends on many risk factors. If you gain a lot of weight, develop constipation or have a job requiring heavy lifting, it may worsen.”

5. Not All Pelvic Organ Prolapse Treatment Involves Surgery

Surgery is not the only option for treating POP. Most people with stage 1 or 2 prolapse will not have significant symptoms or need surgery to feel better. But even if your prolapse symptoms are moderate to severe, there are nonsurgical solutions you can try.

“Don’t let fear of surgical management keep you from coming in for help,” Dr. Foster says. “Just tell us you’re here for help but don't want surgery. There are a lot of nonsurgical things that we can do to help with your symptoms.”

Nonsurgical treatment options for POP include:

• Dietary changes to help your bowels work better
• Pelvic floor exercises or therapy to strengthen muscles
• Pessaries, which are devices that fit in your vagina and support pelvic organs
• Weight loss to remove pressure from the pelvic region

6. Pelvic Prolapse Surgery Can Fix Severe Prolapse

If the symptoms of POP interfere with your quality of life, reconstructive surgery might be a good option.

“Up to 13% of women will have surgery for pelvic organ prolapse in their lifetime,” Dr. Foster says. “Typically, people with stage 3 or stage 4 prolapse want some type of treatment, and often that's surgical management.”

Reconstructive surgery can fix pelvic prolapse by putting pelvic organs back in their original position. It’s typically performed one of two ways:

• Transvaginally, through a small incision in the vagina
• Laparoscopically, using small abdominal incisions and a camera

You’ll likely need to stay in the hospital overnight, and recovery will take about six weeks. “These procedures are safe and effective for pelvic organ prolapse,” Dr. Foster says. “Each surgery is individualized for the type of prolapse and the patient.”

7. There Are Ways to Prevent Pelvic Organ Prolapse

Aging and childbirth put you at higher risk for developing prolapse, but you can take steps to keep prolapse from happening or getting worse. Dr. Foster recommends:

• Fixing your bowel function by getting enough fiber and water every day
• Using vaginal estrogen cream if you are older and need to strengthen your vaginal tissues
• Doing pelvic floor exercises or pelvic floor physical therapy, which includes exercises that target the pelvic floor muscles

Next Steps and Useful Resources

• Want to speak with an OB/GYN? Find one today.