Pelvic Organ Prolapse

What, Why, and How to find help?

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Pelvic Organ Prolapse, known as POP, is a condition that women may experience.

POP is a lowering, or descent of the pelvic organs and their support systems (the muscles, and ligaments) in the pelvic area.

It is present in 20% up to 65% of women and is more likely to occur, after menopause, ages 65 and up. POP can be present at any age, but not cause any trouble. Medically speaking, it is “asymptomatic”.

Most conditions are mild and symptoms do not cause much bother.

However, there may be a bulge beyond the vagina leading to distress and bother, such as difficulties with bladder and bowel storage and emptying, and problems with sexual health and fitness as well. Annoying sensations which can be experienced by women with POP can include feelings of pressure, heaviness, and discomfort in the pelvic area, as well as changes in bladder, bowel, sexual, and fitness functions. These symptoms can come and go depending on how much exertion is needed for daily work and fitness, and the women’s ability to have awareness of manage the pressure in to the pelvic floor.

Ideally, the pelvic floor muscles engage or turn on with optimum force to match the required strength, such as lifting a child, a suitcase, or a barbell.

The reasons why POP develops can include:

  • genetics with a tendency towards looser ligaments and muscles
  • vaginal or cesarean childbirth, involving myofascial stretching
  • birth of a large baby, over 8 1/2 pounds
  • chronic coughing, chronic straining, with pressure downwards into the pelvis
  • lifestyle and fitness activities with pressure downwards into the pelvic with an inability to counteract these pressures well. (Some lift heavy items and workout with no POP)
  • hormonal changes with nursing, and with the menopause transition, aging, with increasing incidence from youth to older years
  • surgeries and injuries to the support systems in the pelvic area
  • obesity

How you can help to reduce the downward pressure into the pelvic area:

  • learn how to control your core muscles
  • learn specialty pelvic exercises for fast, and slow, sustained contractions, which are needed for different types of activity. You may be able to exercise to your full capacity with a progressive program to match your needs.
  • learn hypopressive exercises which use all the breath and the ribcage to help lift the pelvic region, organs and pelvic floor muscles
  • see a pelvic therapist, who can help you fire up your pelvic floor muscles, provide manual and visceral therapy to release stiffness and scar tissue.
  • use intermittent decompression exercises, which eliminate gravity and use gravity assistance.
  • use specialty pelvic health equipment to help your prolapse
  • learn partner communication to help comfort and pleasure with intimate activities

Medical Help can Include:

  • Screening by a gynecologist or urogynecologist.
  • Surgery may be an option for care, and you want the best preparation to achieve surgical success.
  • Medical instruction in the use of a pessary, a support device, and hormone replacement therapy.

For more information on exercise, pressure management, and POP:

Chapter 8

References 3.28.23
Bo K, Angeles-Acedo S, Batra A, et al, International urogynecology consultation/Conservative treatment of a patient with pelvic organ prolapse; Pelvic floor muscle training, IUJ 2022,:33
Crowle A, Harley C, Biotensegrity focused therapy for pelvic organ prolapse: A nonrandomized prospective clinical case series, Journal of Women’s health physical therapy 2021, 45(3).
Hage-Fransen MAH, Wiezer M, Otto A, et al, Pregnancy-and obstetric-related risk factors for urinary incontinence fecal incontinence, or pelvic organ prolapse later in life; A systematic review and meta-analysis, ACTA Obstet Gynecol Scand 2021:100
Weintraub AY, Glinter H, Marcus-Braun N, Narrative review of the epidemiology, diagnosis, and pathophysiology of Pelvic Organ Prolapse, IBJU 2018,:46(1)