2 LOCATIONS:   BETHESDA, MD. 4905 Del Ray Ave, Suite 508   |   MCLEAN, VA. 1305 Vincent Place

Pelvic Organ Prolapse: Types, Causes, Symptoms & Treatment

Receiving a diagnosis of pelvic organ prolapse can feel overwhelming. Questions such as, “What does this mean for me?” and “Can it improve?” may arise, along with a curiosity about what exactly a prolapse is.

Rest assured, we’re here to address all your concerns and provide the information you need to navigate pelvic organ prolapse with confidence!

What are the pelvic organs?

Before we get into the details of pelvic organ prolapse, it can be beneficial to first understand the basic anatomy of the pelvic organs.

Individuals with female anatomy have three different pelvic organs that can be susceptible to prolapse. These include the bladder, the uterus, and the rectum, although this can also happen with parts of your small intestines.

The bladder is positioned closest to the front of the body. The rectum is positioned nearest to the back of the body. The uterus sits between the two.

The pelvic floor muscles lay below your pelvic organs in the shape of a bowl or a hammock, providing support and helping to maintain the ideal position of these organs. 

What is a pelvic organ prolapse?

Prolapse is when an organ in your body has shifted from its normal position. In the case of pelvic organ prolapse, the organs shift downward.

When this happens to the bladder, it is called a ‘cystocele’. This means that the bladder has dropped down and is now leaning back into the front of the vagina. 

When the rectum loses its support it is called a ‘rectocele’. In this case, the rectum falls forward and pushes into the back side of the vagina. 

A prolapse can also happen to the uterus; this is called a uterine prolapse. When this happens, the uterus, which is the central organ in the pelvic cavity, slips down into, and sometimes out of the vagina.

What causes a pelvic organ prolapse?

While childbirth is a common factor contributing to pelvic organ prolapse, it’s important to note that it’s not the sole cause.

Women who haven’t given birth can still experience prolapse. 

Normally, the pelvic organs are held up by fascia and ligaments from above attaching to deep abdominal muscles, and the pelvic floor muscles from below. These supportive structures can also be weakened from constipation, persistent coughing, repetitive lifting, aging (due to hormone changes with menopause) or even following a hysterectomy. 

Weakness in the pelvic floor muscles can also play a role in the development of prolapse.

What are the symptoms of a pelvic organ prolapse?

Symptoms of a pelvic organ prolapse are variable in severity, location, and frequency, but can include a bulging sensation in your vagina or rectum.  Heaviness and pressure sensations in your pelvic area or pelvic organs are also common. You may experience low back pain or the feeling that your pelvic organs are falling out of your vagina which may worsen throughout the day or with being more active. 

With a cystocele or uterine prolapse, you may experience urinary incontinence (leaking urine) or feel like your bladder doesn’t empty all the way after urinating. Those with a cystocele may also experience urinary frequency.

In the case of a rectocele, you may encounter sensations such as rectal pressure or fullness. You also may experience constipation, difficulty having a bowel movement or experience a lingering feeling of incomplete emptying after a bowel movement.

What are some treatment options for a pelvic organ prolapse?

Oftentimes with a prolapse, there is weakness in the pelvic floor muscles. The pelvic floor muscles are the “sling” that supports the pelvic organs. When they are weak, these muscles have more difficulty providing support.

For more mild cases of pelvic organ prolapse, pelvic floor physical therapy can be helpful. A pelvic floor physical therapist can assess your pelvic floor muscle strength and teach you how to strengthen these muscles properly.

Another tool that can sometimes be helpful for strengthening the pelvic floor muscles is biofeedback. Your pelvic floor physical therapist can assess whether this approach is suitable for you.

Your physical therapist will also discuss with you preventative measures to ensure that your prolapse does not worsen. Some preventive measures include learning how to do heavy lifting with proper breath and internal pressure management, and avoiding constipation. Your physical therapist will help provide you with tools on how to lift properly when you need to and discuss ways to prevent constipation.

Another treatment option is a pessary. A pessary is a device that provides support to your pelvic organs. Your pelvic physical therapist can help determine if a pessary is a viable option for you and if so, what type of pessary is best for you.

There are also surgical options for more severe cases of prolapse.

Understanding pelvic organ prolapse is crucial for informed decision-making. If you’re experiencing an issue with a pelvic organ prolapse, we’re here to help.

Contact ITR Physical Therapy today at 301-770-7060 to schedule an appointment with our experienced Bethesda and McLean pelvic floor physical therapy team.