Pelvic Organ Prolapse Types, Causes, Common Symptoms, and Treatment
Written by Liudmila Lahonda, DPT, PT, OCS
Pelvic organ prolapse (POP) is the descent of the pelvic organs below their anatomical position.
The pelvic cavity contains the urinary bladder, urethra, sigmoid colon, rectum, and in females – the uterus and vaginal canal. These pelvic organs are supported by their ligamentous attachments to the pelvic bones and abdominal wall by a fascial connection between those organs, the pelvic cavity, and by pelvic floor musculature support inferiorly. When this support system is compromised, there is a potential for those organs to descend within the pelvic area or even beyond its boundaries.
Current recommendations describe prolapse as anterior vaginal wall prolapse, posterior vaginal wall prolapse, and vaginal apex prolapse. Apical prolapse is referred to as uterine prolapse, cervical prolapse, or vaginal vault prolapse. Anterior vaginal wall prolapse includes cystocele and/or urethrocele, which is a descent of the urinary bladder, urethra respectively, or both. Posterior vaginal wall prolapse is called rectocele when the rectum descents and pushes down into the posterior vaginal wall. There is also rectal prolapse when part of the rectum descents outside the anal opening. Enterocele is when part of the small intestine descents through the vaginal wall. There are also cases of multiple organ prolapse.
Multifactorial with the most common risk factors
- Pregnancy and vaginal delivery
- Increasing age
- Increased BMI
- Chronic coughing
- Repeated heavy lifting
Pelvic Organ Prolapse: Most Common Symptoms
- Pelvic and abdominal heaviness, which is worse with standing
- Vaginal bulging
- Sexual discomfort
- Incomplete bladder or bowel emptying
Pelvic organ prolapse may be asymptomatic as well.
- Physical Therapy with a focus on:
- Education on Intra-abdominal pressure and the role of Pelvic Floor Muscles as a support system
- Education on proper breathing and avoiding bearing down
- Pelvic Floor Muscle strengthening and overall core muscles strengthening
- Education on postural alignment
There are 4 stages of Prolapse: 0 – IV