Article Medically Reviewed By:
Amy E. Rosenman, MD
Clinical Assistant Professor UCLA School of Medicine Santa Monica, CA
Overview
What Is It?
Pelvic organ prolapse (POP) occurs when one or more organs in your pelvis—your uterus, vagina, urethra, bladder or rectum—shifts downward and bulges into or even out of your vaginal canal.
Pelvic organ prolapse (POP) occurs when one or more organs in your pelvis—your uterus, vagina, urethra, bladder or rectum—shifts downward and bulges into or even out of your vaginal canal. In the United States, 24 percent of women have some sort of POP.
Just one symptom associated with the condition—urinary incontinence—costs the country $20 billion annually in direct and indirect medical costs, while surgeries to correct POP cost more than $1 billion annually.
The condition is poised to become much more common in the United States and other Western countries with the aging of the Baby Boomers (women ages 45-63). However, it is important to note that POP is not a condition of "little old ladies." Instead, one major study found that half the women seeking care for the condition were between 30 and 60 years old.
Many women don't have any symptoms of POP. Those who do may experience a feeling of vaginal or pelvic fullness or pressure or feel as if a tampon is falling out. They may also experience incontinence, painful or uncomfortable intercourse, pain in the pelvic area unrelated to menstruation, lower back pain and constipation. Some women also complain of not being able to fully void stools and of fecal soiling of their underwear.
Treatments include lifestyle options, such as exercises to strengthen the pelvic floor, devices designed to support the pelvic organs, physical therapy and surgery to repair damaged ligaments and reposition the prolapsed organs. For women not planning to have sex, obliterative surgeries, which close off the vaginal opening, are also an option. Risk factors for POP include pregnancy (particularly pregnancies that have ended with a vaginal birth), genetic predisposition, aging, obesity, estrogen deficiency, connective tissue disorders, prior pelvic surgery and chronically increased intra-abdominal pressure from strenuous physical activity, coughing or constipation. In many cases, women with POP have at least two or more risk factors.
Having been pregnant with and given birth to a child—particularly two or more children—is a significant risk factor; in fact, it has been estimated that 50 percent of incontinence and 75 percent of POP can be attributed to pregnancy and childbirth. And pregnancy itself is a risk factor, regardless of the method of delivery.
While cesarean section delivery reduces the risk of POP and urinary incontinence, there is still no good evidence to support elective cesarean sections for preventing POP. Having a hysterectomy may also increase your risk of POP, depending on how the surgery was performed and how well ...
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