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Dr. Marena Boctor Nakhla – Laguna Hills

Pelvic organ prolapse (POP) is the descent of one or more organs such as the uterus, bladder, or rectum into the vaginal wall. It is most commonly referred to as herniation. 

Pelvic organ prolapse happens when the pelvic floor muscles are no longer able to support pelvic organs, resulting in a drop of the organs.

Types of prolapse: 

1. Cystocele is when the bladder bulges into the vaginal space. It can also be called anterior wall prolapse.
2. Recotcele happens when the rectum prolapse or herniates into the vaginal space. It can also be known as posterior vaginal prolapse.
3. Uterine prolapse is when the uterus bulges into the vaginal space and can be called anterior wall prolapse.

Now let’s talk about causes for prolapse.

Pelvic Organ Prolapse is mainly caused by pregnancy and vaginal childbirth. Pelvic organ prolapse happens when pelvic floor muscles (PFM) are weak and unable to support the organ. Pelvic floor muscles need to be strong to be able to support the weight of the fetus. After childbirth, pelvic floor muscle starts to fatigue and dysfunction starts to occur.

Prolapse risk factors include:

Laceration, tearing, or stretching can affect the integrity and function of the pelvic floor. Forcep or vacuum-assisted delivery increases the risk of pelvic floor injury.

Grades of pelvic organ prolapse:

Pelvic organ prolapse is rated on a scale of 0-4. Each grade specifies the intensity of the prolapse.

1. Stage 0 is absent or non
2. Stage 1: > 1 cm above hymen
3. Stage 2: 1 cm above or beyond the hymen
4. Stage 3: > 1 cm beyond hymen
5. Stage 4: complete eversion

Symptoms of pelvic organ prolapse 

The most common symptom of all types of vaginal prolapse is the sensation that tissues or structures in the vagina are out of place or feeling that something is coming down. You might also feel pressure or pain in the perineum. Some patients may also feel pelvic or abdominal pain.

Symptoms may be exacerbated with standing or bearing down with bowel movements.

Management of pelvic organ prolapse: 

1. Pelvic floor physical therapy to assess and treat pelvic floor muscle, core strengthening, stabilization exercises, and hip strengthening.
2. Avoid intra-abdominal pressure by managing constipation. Avoid bearing down.
3. Proper lifting mechanics. Always exhale while lifting heavy items.
4. Weight loss. Increased intra-abdominal pressure can increase prolapse.
5. Use of pessary. A pessary is a removable device placed into the vagina to aid in supporting pelvic organs.
6. Loose clothing and supportive garments. Avoid tight and fitted pants as they can increase intra-abdominal pressure.