What Is Pelvic Organ Prolapse?

You’re in the shower and notice something. A soft bulge, inside the opening, that wasn’t there last year. Or it’s not something you can see, only a heaviness low in your pelvis by the end of the day, like something is slowly sliding down. You’ve looked it up, and you closed the tab.

What it is

Prolapse develops when pelvic floor muscles weaken, the NHS¹ says, and an organ sags into the vagina. Cleveland Clinic² lists six types: anterior vaginal wall prolapse (a cystocele, the most common), urethrocele, posterior vaginal wall prolapse (rectocele), enterocele, uterine prolapse and vaginal vault prolapse. See pelvic floor dysfunction.

Symptoms

Cleveland Clinic² says the main complaint is feeling a bulge in the vagina, as if something were falling out. Others include pelvic fullness, pressure during sex, leaking when you cough or laugh, a constant urge to pee, and constipation or bowel control problems. The NHS¹ adds urinary, bowel and sexual symptoms. See leaking when you cough, painful sex and constipation.

Why it happens

Cleveland Clinic² says vaginal childbirth is the most common cause. Other risk factors it lists include aging with declining estrogen in menopause, heavier body weight, chronic pressure in the abdomen from constipation, coughing or heavy lifting, family history and connective tissue diseases. The NHS¹ lists pregnancy and childbirth, being overweight, chronic constipation, persistent coughing and pelvic surgery, and says it’s more common in women over 50. See childbirth and the pelvic floor and aging and bladder control.

How it’s checked

Cleveland Clinic² says providers do a pelvic exam, sometimes asking you to cough, and may do pelvic floor tests, bladder assessments, ultrasound or MRI in complex cases. The POP-Q system stages severity from zero, no shift, to four, complete prolapse outside the vagina.

What helps

Pelvic floor exercises. The NHS¹ and Cleveland Clinic² both list them. See Kegels.

Self-help. The NHS¹ lists a healthy weight, fibre, avoiding straining and heavy lifting, and stopping smoking because coughing stresses the pelvic floor. Cleveland Clinic² suggests squatting with a straight back when you lift, and preventing constipation.

A pessary. Cleveland Clinic³ describes a removable silicone device that your provider can insert into the vagina to hold a sagging organ in place, and says people choose it for relief without surgery or when surgery is risky. Fitting happens at an office visit, and more than one fitting may be needed. Removable ring types need weekly or nightly cleaning with mild soap and water, with follow-up every 6 to 12 months if you remove it yourself or every 3 to 6 months if the provider does. It says pink or bloody discharge may mean it’s rubbing the vaginal walls, an unusual odor may mean infection, and low-dose vaginal estrogen may help heal irritated tissue.

Vaginal estrogen. The NHS¹ lists hormone therapy applied vaginally among conservative options. See menopause and bladder control.

Surgery. The NHS¹ says surgery may be considered for severe cases, and notes that vaginal mesh surgery is no longer done on the NHS unless there’s no alternative. Cleveland Clinic² lists several operations, including native tissue repair, colporrhaphy, and procedures that narrow the vaginal opening or use mesh. Your surgeon can explain which applies to you.

The play

Try this: a symptom and trigger note

For two weeks, write down when you feel the bulge or heaviness (end of the day, after lifting, with a cough, during a bowel movement), and how bad it is from 1 to 10.

Add leaks, constipation, pain with sex and how you empty your bladder and bowels.

Bring the note to your appointment and ask about a pelvic floor physical therapist, a pessary and what stage you’re at.

When to get checked

The NHS¹ says to see a doctor if you have a lump in or around your vagina or other symptoms that affect daily life. Cleveland Clinic² says to contact a provider for pelvic pressure or fullness, discomfort with sex, a bulging sensation, bowel control loss or urinary leakage.

Book an appointment if any of these fit:

• You feel or see a bulge in or at your vagina
• Heaviness or pressure is affecting your day
• You have new leakage, urgency, constipation or bowel control problems
• Sex has become uncomfortable
• You use a pessary and have pain, pink or bloody discharge or an odor

A bulge is a recognized, treatable finding. The call is easier than the dread.