Pelvic Organ Prolapse (POP)

Pelvic organ prolapse (POP) occurs when the supporting muscles and tissues of the pelvic organs become weak or loose. Because of this slackness, one or more of the pelvic organs — the bladder, uterus, and rectum — can drop into or push out of your vagina.

If you have pelvic floor prolapse, don't be embarrassed to talk to your doctor. This pelvic floor disorder is treatable.

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On this page:

• What Is Pelvic Organ Prolapse?  
• What Are the Symptoms of Pelvic Organ Prolapse?  
• How Do You Diagnose Pelvic Organ Prolapse? 
• How Do You Treat Pelvic Organ Prolapse?  

What Is Pelvic Organ Prolapse?  

Doctors define pelvic organ prolapse (POP) as a weakening in the muscles and tissues that support your pelvic organs, which include the bladder, rectum, and uterus. This weakening can allow one or more of the organs to drop into or push out of the vagina.

The pelvic muscles and tissues support your pelvic organs like a hammock. A prolapse happens when these muscles and tissues are damaged or weakened and can no longer support the organs.

Pelvic organ prolapse is one of the most common pelvic floor disorders.

Other common pelvic floor disorders include:

• Fecal incontinence (leaking stool).
• Urinary incontinence (leaking urine).

Some people develop more than one pelvic floor disorder, such as POP along with urinary incontinence.

How common is pelvic organ prolapse? 

Pelvic organ prolapse will affect almost 20% of people who were female at birth in the U.S., and almost 10% could need surgery for POP. POP generally happens more in postmenopausal women, although it can happen in younger patients as well.

What are the different types of pelvic organ prolapse?

The most common types of pelvic organ prolapse include:

• Back vaginal wall prolapse or rectocele — When the rectum pushes into or out of the vagina.
• Enterocele (small bowel prolapse) — When part of the small intestine or small bowel pushes into the vagina.
• Front vaginal wall prolapse or cystocele (dropped bladder) — When the bladder pushes into the vagina. It's the most common type of POP.
• Uterine prolapse (dropped uterus) — When the uterus drops into or out of the vagina.

You can develop POP after you've had a hysterectomy. In this case, part of the vaginal wall can drop and cause a bulge into or out of the vagina.

What causes pelvic organ prolapse?

The most accepted causes of POP are a combination of vaginal childbirth, menopause, and genetics.

What are pelvic organ prolapse risk factors and complications?

Pelvic organ prolapse risk factors

A few factors can put you at risk of pelvic organ prolapse.

Giving birth

Vaginal childbirth can stretch and strain the pelvic floor, and multiple vaginal births can raise your risk of POP later in life. Delivering large babies can also increase your risk of POP

In some recent studies, the risk increased with the number of children delivered, and the risk was slightly greater if forceps or a vacuum device were used during delivery. Having a cesarean section (C-section) delivery reduces but doesn't eliminate the risk of POP. POP can also less commonly affect women who've never been pregnant.

Hormonal changes

Changes in hormone levels during perimenopause and after menopause can raise your risk of pelvic organ prolapse.

Pressure on the pelvic floor

Things that can increase pressure on the pelvic floor include:

• Chronic constipation or straining to poop.
• Chronic coughing (due to smoking or other health issues).
• Heavy lifting.
• Obesity or being overweight.

Weaker tissues

Your genetics play a role in how strong your bones, muscles, and connective tissues are. Some conditions that affect the strength of connective tissues put certain people at a higher risk of POP.

Your age

Pelvic floor muscles can weaken as you age and during menopause, which is why pelvic organ prolapse is more common in older people.

Complications of pelvic organ prolapse

POP often causes bothersome symptoms, but POP does not often lead to serious problems or complications. People with POP can schedule a visit with their gynecologist or urogynecologist. Occasionally, POP can cause difficulty with complete urination, which could need a more urgent visit.  

How can I reduce my risks of pelvic organ prolapse?  

You can reduce your risk of pelvic organ prolapse by:

• Eating high-fiber foods to prevent constipation and straining during bowel movements.
• Losing weight if you're overweight or obese.
• Stopping smoking, as chronic coughing puts stress on the pelvic floor muscles.

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What Are the Signs and Symptoms of Pelvic Organ Prolapse? 

Symptoms of pelvic organ prolapse include:

• Feeling like something is slipping or falling out of your vagina.
• Pelvic pressure.
• Problems getting tampons to stay in place.
• Seeing a bulge or something coming out of your vagina.
• Trouble emptying your bladder.
• Vaginal discomfort or fullness.

Some women report that their symptoms worsen:

• After standing for a long time.
• At the end of the day.
• During physical activity or lifting.

When should I see a doctor about my POP symptoms?

If you have POP symptoms, don't be embarrassed to talk to your doctor. Don't dismiss what you're experiencing as a normal part of aging. Pelvic organ prolapse is treatable.

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How Do You Diagnose Pelvic Organ Prolapse?  

Your doctor will ask you about your symptoms and do a pelvic exam. They may ask you to strain or cough during the exam so they can see whether these actions cause prolapse or urine leakage.

Tests to diagnose pelvic organ prolapse

Your doctor also may order tests to see if your bladder empties completely when you pee.  

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How Do You Treat Pelvic Organ Prolapse?  

You may not need treatment if your POP symptoms don't bother you. If this is the case, your ob-gyn or primary care provider will monitor your pelvic organs over time and provide treatment options if needed.

Treatment for pelvic organ prolapse depends on the type of prolapse you have, your symptoms, and other factors.

They'll decide the best treatment for you based on your:

• Age.
• Degree of prolapse.
• Desire for future children.
• Other health problems.
• Severity of symptoms.
• Sexual activity.

They may refer you to a urogynecologist for treatment. This is a doctor who specializes in treating pelvic support and urinary problems.

Pelvic floor physical therapy 

Your doctor may refer you for pelvic floor physical therapy (PT). This special type of PT can strengthen your pelvic floor muscles and help with other pelvic floor disorders.

Pessary for POP

A pessary is a medical device that supports the vagina and keeps the bladder, uterus, and rectum in their proper positions. Your doctor will insert the pessary into your vagina. Depending on the type of pessary, you may be able to remove and reinsert it to clean it or to have sex.

Surgery for pelvic organ prolapse

We may discuss surgery:

• Colpocleisis (surgery to narrow and shorten the vagina) — This surgery is performed through the vagina. It shortens the vagina and makes the vaginal opening narrow. The procedure involves sewing the vaginal walls and muscles together by entering through the vagina without any abdominal incisions. This option can work for women who don't plan to have or who no longer have vaginal intercourse. It is highly successful.
• Surgery to support the uterus or vagina — Your surgeon may use your own body tissues or synthetic mesh to fix the prolapse and build support for the pelvic floor. Surgeons perform this type of surgery on women who want to maintain the ability for sexual activity.
• If you have a uterus in place, the surgeries can be done with or without a hysterectomy (removing the uterus). Talk to your doctor about which is best for you.
• If you have already had your uterus removed in a hysterectomy, these surgeries can be performed on the vagina.

Is mesh safe to use during surgery to repair pelvic organ prolapse?

During surgery to repair POP, your surgeon may enter through the vagina or laparoscopically through the abdomen. They may use surgical mesh to repair pelvic organ prolapse minimally invasively through the abdomen. But because of safety issues, mesh is no longer used in transvaginal (through the vagina) prolapse repairs. Your doctor can further explain these differences, and you should feel free to ask questions.

If you had a prior transvaginal POP surgery with mesh, you may not need to do anything if you don't have any problems. But you should let your provider know if you start to have symptoms.

Signs that you should call your doctor include:

• Pain during sex.
• Pelvic or groin pain.
• Vaginal bleeding.
• Vaginal discharge.

If you’ve had transvaginal POP surgery but don’t know whether your surgeon used mesh, ask them at your next visit.

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Why Choose UPMC for Pelvic Organ Prolapse Care?  

The Center for Minimally Invasive Gynecologic Surgery offers a range of surgical treatments, depending on the type of prolapse that you have.

Your surgeon will review your options with you and recommend the treatment that's best for you.  

By UPMC Editorial Staff. Last reviewed on 2024-09-05 by Lauren Giugale, MD.