Pelvic Organ Prolapse (often shortened to “POP”) is the term used to describe any of the pelvic organs sliding down from their normal positions into the vagina. In women, the condition usually occurs when the pelvic floor sinks down after gynecological cancer treatment, childbirth or heavy lifting. Treatment can involve dietary and lifestyle changes, physical therapy, pessary use (don’t worry, we’ll be doing a whole post on pessaries!), and surgery.
The way we organize and classify prolapses can get a bit confusing, so let’s do a quick run through here:
When the prolapse comes from the front of the vagina, we call it an “anterior vaginal wall prolapse”. When this is occuring, it’s typically the bladder or the urethra which is the culprit. If it’s the bladder dropping down, we call it a “cystocele” and if it’s the urethra, we call it a “urethrocele”. Sometimes it’s both and we combine the name to call it a “cystourethrocele”.
When the prolapse comes from the back of the vagina, we call it a “posterior vaginal wall prolapse”. With these, it’s typically the small intestine or rectum which is pushing forward into the vagina. If it’s the rectum, we call it a “rectocele” and if it’s the small intestine we call it an “enterocele”.
The last main direction organs can drop into the vagina is from the top. If this is occuring, it’s called an “apical vaginal prolapse”. Apical prolapses are a result of the uterus dropping, which we simply call a uterine prolapse (easy enough!). Sometimes after the uterus has been removed surgically, the top of the vagina itself can drop down and we call this a “vaginal vault prolapse”.
The degree to which the pelvic organs have dropped can vary in severity and is classified into different stages. Low stages mean that the organ(s) in question is only dropping down slightly while higher stages can mean the organ(s) is coming fairly far out of the vagina.
Treatment for POPs will depend on many factors, most importantly the stage of your prolapse. Low stages can be treated with guided pelvic floor exercises and education of pressure management. High stages may require surgery to anchor the offending organ back in place or restore the tissue which should have been keeping it there in the first place. When stages are somewhere in the middle, a pessary may be helpful. A pessary is a device that can be placed into the vagina to hold everything where it needs to be. Simple pessaries can be tried over the counter, but more substantial support will require fitting by a trained professional. Thankfully, more and more pessary options are now available to work for your own unique body.
Regardless of whether you end up using a pessary or undergoing surgery, it is important to work with a pelvic floor provider to guide you in a pressure management, stability, and kegel program to make sure you remain well supported.