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Pelvic Organ Prolapse (POP)

Pelvic organ prolapse (POP) is a common problem. Women with POP may notice a bulge coming from the vagina when they wash or wipe, or just going about daily activities. It usually isn’t painful, but can be very uncomfortable and can cause a feeling of pressure. Many women with POP say it is better or even gone when they wake up in the morning, but becomes worse and more noticeable during the day, especially if they are on their feet a lot.

POP is caused by a weakness of the ligaments and muscle that normally holds up the bladder, vagina, uterus, and rectum. There can be weakness in just one area, such as the bladder, or more.

POP is usually NOT dangerous but it can be very uncomfortable and interfere with healthy living, so it should be treated.

Why does pelvic organ prolapse happen?

We don’t know. We do know that women who have been pregnant and had vaginal or forceps deliveries are more likely to have this problem.

However, many women who have these experiences do not develop POP, and some women who have never been pregnant develop it. It can also be something that runs in families. Overall, it appears to be a combination of factors – some risks a woman is born with and others that happened during her life.

What can be done for pelvic organ prolapse?

You may be referred to a specialist who will want to examine you, and may ask for more testing. There are several treatment options including:

  • Specialized physical therapy to help strengthen the muscles that support the vagina, bladder and rectum.
  • A pessary to support the organs (bladder, uterus, rectum) that have lost support. This vaginal insert – often in the shape of a ring – is fit to the woman’s body so it is comfortable. Most women who use a pessary do not feel it at all when it is in place. The pessary is not permanent and has to be removed periodically either by the patient or her doctor to be washed and then put back in. However, the pessary can be used for years, and many women find this to be an excellent long-term solution.
  • Surgery. Women can try physical therapy and/or a pessary and if they are not happy for any reason, they can discuss surgical options with the urogynecologist. There are many ways to fix POP surgically depending on the organs that have lost support and other factors that are unique to each patient. Below is a list of possible surgeries. Often, more than one will be done at the same time if the support of more than one organ is weak. Not all the surgeries in this list would be appropriate for every woman with POP. It is best to discuss the various options with the urogynecologist to determine what is best for you.

If the bladder has lost support:

Anterior colporrhaphy (anterior repair) is done through the vagina and fixes the supportive tissue between the vagina and the bladder with stitches. This is often done with other prolapse surgery.