Bringing Pelvic Organ Prolapse Out of the Shadows

By Amie Newman |

Recently, I was at a baby shower. I overheard a mother of two teenagers relay the story of her many postpartum surprises to a young woman with no children who wondered out loud what kinds of changes happen to a woman’s body after giving birth. One of the shocks the older mother shared included problems with urinary incontinence that followed her pregnancies and never entirely went away.

It may not have been typical party conversation, but as more women dig past their embarrassment to share their experiences with urinary incontinence and other pelvic floor disorders, we chip away at the stigma that prevents women of all ages from seeking help.

One pelvic organ disorder common in women — particularly in women who have given birth — is pelvic organ prolapse. We recently published a new health article on the topic.

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Pelvic organ prolapse — sometimes called genital prolapse — is rarely discussed, yet millions of women in the United States suffer from what the Washington Post has called a hidden medical epidemic. The condition occurs when one or more of the pelvic organs — the uterus, bladder, or rectum — slip down from their normal position and either press against the wall of the vagina or protrude into the vagina. An organ can bulge out the vaginal opening as well.

Carmel Price, a sociology professor, told the Washington Post that after she had two children,

My bladder was bulging outside of my body, and if I was on my feet for any significant length of time, like if I was giving a three-hour lecture, or running or jumping, it would fall out even further.

Rice is hardly alone. According to our prolapse article, these conditions are most common in postmenopausal women who have given birth, but can also occur in younger women and women who have not given birth. It is estimated that at least half the women who have given birth to more than one child have some degree of prolapse.

Prolapses occur when there is a weakening or a collapsing of the pelvic floor, the structures which hold the pelvic organs in place. Pregnancy and childbirth, menopause and aging, genetics, obesity, repetitive heavy lifting, and certain conditions like chronic coughing can cause significant weakening of the pelvic floor, leading to a prolapse.

There are levels of prolapse severity: first, second, third, and fourth degree prolapse. There are also different types of prolapse. Symptoms of prolapse differ according to the organs involved and the severity of the prolapse. Many women with minor prolapses, for example, have no or only minor symptoms.  Women who aren’t experiencing any problems from the prolapse do not need treatment.

One common type of prolapse is a prolapse of the bladder, called a cystocele. A cystocele occurs when the tissues supporting the wall between the bladder and vagina weaken and a portion of the bladder pushes into the vaginal walls, which then bulge into the vagina. Some women with this type may experience urinary problems including involuntary leaking of urine and urinary infections.

Women who suffer from a uterine prolapse, when the uterus and cervix descend down into the vagina due to weak or damaged pelvic support structures, might feel a dragging sensation or that something is falling down.

Many women live with symptoms from a prolapse for years and don’t know that something can be done. They may experience decreased sensation during sex or fecal incontinence and still, whether because they believe they are the only one or fear the stigma, they don’t seek help. That can cause further problems, according to the Washington Post:

Left untreated, the prolapse can grow to the size of a grapefruit or larger, and it can become painful if the organs pull on the ligaments that connect to the sacrum. It can become dangerous if the prolapse causes blockage in the tubes that attach kidney to bladder, and it can put older women at risk of reduced activity and social isolation.

It’s important for women to know there are treatments available. Some treatments, like lifestyle changes and physical therapy, are considered more conservative in approach and so are generally tried first. Pessaries, a device inserted into the vagina to provide support to the pelvic floor, offer a temporary solution to pregnant women or, in some cases, a permanent solution to women who are not good candidates for surgery.

Surgery carries more risk than less invasive procedures but is often the best treatment for women with more severe prolapses. Surgery is done to repair and reconstruct the pelvic support structures so that the pelvic organs are restored to their normal positions. There are a number of different surgical options and choosing one depends upon which organ(s) have descended, a woman’s age, history of previous pelvic surgery, and whether she wishes to retain her uterus.

While only 10-20 percent of women who have a prolapse actually experience symptoms or discomfort, it’s important to name this “hidden” condition, to bring it out of the shadows, and to let women of all ages know they are not alone. Pelvic organ prolapse is not something a woman just needs to live with. There are millions who have suffered with this condition but who have found the treatment that’s right for them. For more detailed information, please read our article, Pelvic Organ Prolapse .

We are immensely grateful for the expertise of the OBOS contributors who worked on the pelvic organ prolapse article: MJ Strauhal, a physical therapist who specializes in pelvic floor dysfunction, and doctors Carolyn Swenson, a specialist in female pelvic medicine and reconstructive surgery, and Amy Rosenman, recent president of the American Urogynecolgic Society.

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13 Comments

  1. SD says:

    There are solutions outside of surgery and pessaries! Please interview Katie Bowman. Her exercises were the solution to the incontinence I had after pregnancy. It took about 8 months, but it worked and 5 years later is still resolved!

    • Amie Newman says:

      Hi SD,

      Thank you for sharing! Yes, physical therapy as mentioned in the post is definitely an option for some. And we will certainly research Katie Bowman. I’m grateful for your comment!

      Amie

  2. Mary says:

    i suffered from bladder prolapse which I never realised could be so painful. I had an enormous bladder capacity and when I emptied my bladder it was very stingy indeed. I have had a hysterectomy with g.reat relief and sex is possible again. I am now 51 years old

    • Amie Newman says:

      Hi Mary,

      I’m sorry that you had to suffer through a prolapse though relieved that a hysterectomy rid you of pain and symptoms. Thank you so much for sharing your experience.

      Amie

  3. Jackie says:

    I have a grade 3 bladder proplapse,grade 2 rectum and womb prolapse.i’m supposed to be having a hysterectomy and repair in october but being a severe agraphobic i’m terrified.i can’t stay away from my home and won’t be put to sleep,i can an epidural but i want someone i trust with me when i have the operation,they don’t think this is possible.If a father is allowed in theatre when his wife has a cesarien,why aren’t people like me allowed.This operation would give me a quality of life i haven’t had in years,i’m in pain,and need to wee every 15 mins,it is true that women suffer alone,this condition affects every aspect of my life,i really don’t want an operation but was told that no amount of excercise would help.I can’t see any future,can’t be intimate any more,can’t lift heavy things.There is no funding for any therapy any gp just passes the buck to the hospital.I wonder how many other women feel helpless like me,things seem 100% worse when you live like this day in day out,it isolates you and makes you feel that you’re the only one with this problem.

    • Shirley Aschwanden says:

      I’m sorry no one has yet answered your post. I am researching the types of prolapse for myself as i am soon to see a gynecologist for other issues, but also know i have a prolapse but not which type yet. I wonder if a counselor from the hospital could help you get some answers. I wish you all the best with this. I do know getting the help you need can be life changing with both agoraphobia and such surgery.

  4. There is no mention in your article of the disability that may stem from 2nd, 3rd, or even 4th surgeries that MAY be deemed necessary. Or from the health conditions that may occur following the removal of the uterus. (Years of chronic illness postoperatively have been well-documented by several gynaecologists… Dr Roberts, Dr West and several others.) And I have spoken to dozens of women over the years who bitterly regret ever having had their first POP operation.
    I have been living with two prolapsed organs for several years. Uncomfortable, unpleasant, but not unbearably painful. I am now aged 80 and a full-time carer for my 90–year-old husband whose life has been ruined, not by ‘old age’ but by aggressively prescribed pharmaceutical drugs. All factors indicate a poor surgical risk for me – and a post-operative nightmare scenario for both my husband and I should I survive with future complications. I have therefore declined to have a hysterectomy and bladder repair.
    Despite my imperative need to remain capable of functioning (for if incapacitated, my partner and I will both suddenly be in Care Homes), it is of interest to me that this possibility is not listened to by the gynaecological hospital dept that I attend; in fact the surgeon – whom I have not yet met – has told the nursing staff, ‘Can you not just persuade her to have the operation!’
    Perhaps you could explain to me why my wishes and home circumstances are not considered relevant to any medical discussion. And why there is no mention in your write-up of the possibility (remote or otherwise) of lives being ruined by pain and subsequent chronic ill health.

  5. Barry says:

    Have any of you heard of the Hideaway Prolapse Solution. It is being used by my wife who is in her 70;s to stop her prolapse bladder from falling out. It is an alternative for her to use this because she cannot have surgery and a pessary caused too much discomfort and infections for her. Those ladies like my wife need to check out this Hideaway prolapse solution because my wifes doctor recommended it for her. My wife wanted me to share this information with other women who suffer prolapse. Thanks.

  6. I am 72 years old and have pelvic organ prolapse with a ring pessary fitted. My bladder (cystocele) is stage 3 and bothered me when walking and the continual pressure felt like I needed to empty it a lot. It blocked the urethra and I could only empty it by pushing it back up and standing, awful. I then thought to buy large size tampax, and using it pushed the bladder back in place and I can now sit to empty it and it does not prolapse. I believe you can also get inflatable pessaries which would do the same thing.

  7. Holly Droske says:

    Not only older women who suffer with POP also experience reduced social activity and isolation (from the Washington post quote). I would love to see some focus on POP in pre-menopausal women who have NOT had children. I have been scouring the internet for some information or support more specific to myself and am coming up empty handed. Also, likely the number of women with POP or who experience symptoms from their POP is most likely highly inaccurate….since many women do not report their symptoms, do not have access to affordable high quality healthcare, or are too embarassed to bring it up. Oh, or they get shutdown by their gyno when they try to discuss it, like I did.

  8. Anne says:

    Mom had it,, prolapse of the bladder.. -She had the operation at 85, and it hurt like hell.. She was bent over for months, as the pain was so severe… – They really butchered her up.. – Make sure you really need that operation,, because you will suffer afterwards…

    • Barry says:

      I am so sorry to hear your mother had that painful operation. My wife was saved by that by wearing the Hideaway Prolapse outside support. It is going to be doctor recommended very soon as it has been tested. The reason I am telling you this is because my wife wants me to help others who are walking in her shoes and cannot have surgery. She is doing so well by wearing her Hideaway everyday. It stops her prolapse from falling out and she can go for long walks again and do anything she wants. She is pushing 80 soon so no operations for her. Thank Goodness for the Hideaway. Barry

      • Bron says:

        I personally would like to thank you Barry, and your wife, for sharing this very important, and helpful knowledge. It is only by others sharing their experiences, that we can learn of Alternative treatments. I have never heard of the Hideaway Prolapse outside support: but will now do my reseach on same. I have had a Hysterectomy and A & P Repair. My problem now is painful intercourse ?secondary to Fibromyalgia. However, I will also look further into what you have given us, and see if this maybe of help to me. Once again, Thankyou. Much Appreciated.