Understanding Pelvic Organ Prolapse (POP)

Pelvic organ prolapse (POP) is a medical condition that occurs when the pelvic organs, such as the uterus, bladder, or rectum, descend or “prolapse” into the vaginal canal. This happens when the supporting muscles and tissues in the pelvic area become weakened, stretched, or damaged, which can occur due to pregnancy and childbirth, menopause, chronic coughing, heavy lifting, obesity, or other factors.

Symptoms of POP can include a feeling of pressure or fullness in the pelvic area, a sensation of “something falling out” of the vagina, difficulty urinating or having a bowel movement, and pain during sexual intercourse. These symptoms can vary depending on the severity and type of POP.

There are different types of pelvic organ prolapse, depending on which organ is affected. Some common types include:

1. Cystocele: This occurs when the bladder prolapses into the vaginal canal.
2. Rectocele: This occurs when the rectum prolapses into the vaginal canal.
3. Uterine prolapse: This occurs when the uterus descends into the vaginal canal.

Additional types of prolapse include enterocoele and vaginal vault prolapse.  Enterocele is a type of pelvic organ prolapse that occurs when the small intestine bulges or protrudes into the vaginal canal. It can happen when the muscles and ligaments that support the pelvic organs weaken, allowing the intestine to push into the vaginal wall. This can lead to a bulge or protrusion in the vaginal area, as well as symptoms such as pelvic pressure, discomfort, and pain during sex. Enterocele can be diagnosed through a physical exam or imaging tests such as an MRI or ultrasound.

Vaginal vault prolapse is a condition where the upper portion of the vagina descends or prolapses into the lower part of the vagina or outside the vaginal opening when there is no uterus or cervix after surgery. This can occur when the muscles and ligaments that support the vagina become weakened or damaged, such as after childbirth, menopause, or surgery. Symptoms of vaginal vault prolapse can include a feeling of vaginal fullness or pressure, discomfort or pain during sex, and difficulty with bowel movements or urination.

Treatment for pelvic organ prolapse depends on the severity and type of POP, as well as the individual’s overall health and preferences. Treatment options can include pelvic floor physical therapy, lifestyle changes, pelvic support devices such as pessaries, and surgery. It is important to consult a healthcare professional for an accurate diagnosis and personalized treatment plan.

Pelvic organ prolapse (POP) can be graded using the Pelvic Organ Prolapse Quantification (POP-Q) system. This system is based on the measurement of the descent of the pelvic organs relative to specific points on the vaginal wall. The POP-Q system allows doctors to determine the severity and location of the prolapse, and helps guide treatment decisions.

The POP-Q system involves a physical exam where the patient is placed in a semi-recumbent position and the doctor uses a specialized ruler and other instruments to measure the position of the vaginal walls and cervix. Based on the measurements taken, the prolapse can be graded from 0 to 4:

• Grade 0: No prolapse observed.
• Grade 1: The prolapse descends to the upper two-thirds of the vagina.
• Grade 2: The prolapse descends to the lower third of the vagina.
• Grade 3: The prolapse protrudes beyond the vaginal opening.
• Grade 4: The prolapse is completely outside the vaginal opening.

The POP-Q system also includes other measurements that can help identify the type and severity of the prolapse. These include measurements of the perineal body length, genital hiatus, and total vaginal length.

The POP-Q system is widely used and has been shown to be reliable and reproducible. However, it is important to note that the grading of pelvic organ prolapse should always be done in conjunction with a thorough patient history and physical examination to determine the best treatment plan for the individual patient.

Staging of the prolapse can vary and change and is not necessarily a permanent or fixed position. 

Pelvic organ prolapse (POP) occurs when the muscles and tissues that support the pelvic organs become weakened or damaged, causing the organs to drop or prolapse into the vaginal canal. The following factors can contribute to the development of pelvic organ prolapse:

1. Pregnancy and childbirth: The stretching and straining of the pelvic floor muscles during pregnancy and childbirth can cause damage to the muscles and tissues that support the pelvic organs.
2. Menopause: The decrease in estrogen levels that occurs during menopause can lead to a loss of elasticity in the pelvic muscles and tissues, contributing to the development of POP.
3. Chronic constipation: Straining during bowel movements can put pressure on the pelvic muscles, leading to weakening and damage.
4. Chronic coughing: Conditions such as asthma or chronic bronchitis can cause frequent coughing, which can also put pressure on the pelvic muscles and contribute to POP.
5. Obesity: Being overweight or obese can put additional pressure on the pelvic muscles and contribute to the development of POP.
6. Heavy lifting: Regularly lifting heavy objects can put strain on the pelvic muscles and contribute to weakening and damage.
7. Genetics: Some women may have a genetic predisposition to pelvic organ prolapse.

It is important to note that not all women who experience these factors will develop pelvic organ prolapse, and some women may experience POP without any apparent cause.

Physical therapy for pelvic organ prolapse (POP) is a type of treatment that aims to improve the strength and function of the pelvic floor muscles to alleviate symptoms of POP. Pelvic floor physical therapy is often used as a first-line treatment for mild to moderate POP before more invasive treatments such as surgery are considered.

A pelvic floor physical therapist can assess the severity of POP and develop an individualized treatment plan based on the patient’s specific needs. Treatment may include:

1. Pelvic floor muscle exercises: Also known as Kegel exercises, these exercises involve contracting and relaxing the muscles of the pelvic floor to strengthen them and improve their ability to support the pelvic organs.
2. Biofeedback: This technique involves using sensors to measure muscle activity in the pelvic floor during exercises, allowing patients to see how well they are engaging the correct muscles and make adjustments as needed.
3. Electrical stimulation: This involves using a small electrical current to stimulate the pelvic floor muscles and improve their strength and function.
4. Education and lifestyle modifications: A pelvic floor physical therapist can provide education on proper bladder and bowel habits, posture, and lifting techniques to minimize strain on the pelvic floor.
5. Pelvic support devices: A therapist can also provide instruction on the use of pelvic support devices, such as pessaries, to help support the pelvic organs and alleviate symptoms of POP.

Pelvic floor physical therapy for POP is typically performed over several sessions and may be combined with other treatments, such as medication or surgery, depending on the severity of the condition.

At West Physiotherapy, we consider the whole person including, the pelvic floor, a woman’s overall strength and posture, and her lifestyle to create a personalized plan to help her understand her body and get her back to feeling confident with daily life and exercise!