After all the changes that happened to your body through pregnancy, you’d think nothing could surprise you. But having one of your pelvic organs (as in your uterus, bladder, or bowels) slip out of place can come as a shock.
Chances are, your OBGYN never mentioned this common type of pelvic floor dysfunction (it’s present in up to 50% of the female population, though most individuals don’t realize they have it). If your doctor did talk to you about PFD, research shows that the conversation was probably limited to incontinence. So if you’re feeling blindsided by prolapse, you’re not alone — and are in the right place.
Getting help for pelvic organ prolapse is so important. If left untreated, the pain and discomfort can significantly impact your life and how you feel in your body. At Origin, we’ve helped hundreds of patients improve pelvic organ prolapse with pelvic floor physical therapy, a safe and effective treatment that can eliminate the need for surgery.
Keep reading to learn more about pelvic organ prolapse, do your own self-assessment at home, and find out if making an appointment with a pelvic floor physical therapist is right for you.
What is Pelvic Organ Prolapse?
To help you better understand pelvic organ prolapse, let’s quickly review the anatomy and how your pelvic organs interact with your pelvic floor muscles.
The pelvis is the ring of bones at the base of your spine that safely houses your bladder, bowels, vagina, and uterus (aka your pelvic organs). Your pelvic organs are held in place by various ligaments and connective tissues. At the bottom of your pelvis is the pelvic floor, a bowl-shaped group of muscles, nerves, and connective tissues. Your pelvic floor has multiple jobs to do, including supporting your pelvic organs from below (this easy easy-to-understand analogy shows exactly how your pelvic floor helps to keep everything in place.
Pelvic organ prolapse occurs when the muscles and connective tissues in your pelvic floor become too damaged and weak to support your pelvic organs, causing an organ (or part of an organ) to drop down into the vaginal canal or rectum.
Some of the most common risk factors for developing pelvic organ prolapse include pregnancy, vaginal delivery, and increased body mass index. Connective tissue disorders as well as excessive or chronic pressure or straining (think chronic constipation, lots of heavy lifting, or even the coughing associated with COPD) can also eventually lead to pelvic organ prolapse.
Types of Pelvic Organ Prolapse
Prolapse can involve the bladder, urethra, uterus/cervix, rectum, vagina, and/or the small intestines. Prolapses are categorized based on which organ is dropping and where it's going.
Apical Prolapse occurs when there's a displacement of organs down from the top of the vagina. This may include the cervix, uterus, the vaginal vault, or even the small intestines (enterocele).
Anterior Prolapse describes the displacement of organs from the front of the vaginal vault and may include the bladder (cystocele), the urethra (urethrocele), or both (cystourethrocele).
Posterior Prolapse involves the displacement of the organs from the backside of the vaginal vault and includes the rectum (rectocele), it's referred to as a posterior prolapse.
Perineal Prolapse happens when support is lost in the perineal body (space between the vaginal and anal openings) causing these tissues to bulge away from the body.
Rectal prolapse is when rectal tissue is displaced down into the anal opening (as opposed to the vaginal vault - see posterior prolapse).
Symptoms of Pelvic Organ Prolapse
Depending on which organ(s) are involved and the stage of your prolapse, some of the more common symptoms may include:
- Heaviness or pressure in the vagina
- A feeling like something is falling out of you
- You may feel or look different down there (ie you feel or see tissue dropping out)
- New difficulties having a bowel movement
- Urinary incontinence or even a difficulties fully emptying your bladder
- Pain or sensation changes with penetrative intercourse
THE 4 Stages of Pelvic Organ Prolapse
No matter which organs are involved, the tissues can drop down a little, or a lot. Determining your “stage”, or how much your prolapse drops down, may help your healthcare provider determine your treatment options, and even help to determine how well you may do with long-term recovery. Commonly the hymen (or the hymenal remnants) are used as the anatomical landmark to measure around. Here are the stages to know:
- Stage 0: No prolapse! Everything is where it anatomically should be.
- Stage 1: There is some dropping into the vaginal walls, but at its lowest point, the prolapse is more than 1 cm above the level of the hymen.
- Stage 2: The prolapse has dropped a bit more and includes tissue that is between 1 cm above or below the hymen.
- Stage 3: When the tissues drop further than 1 cm past the hymen, but no more than 2 cm.
- Stage 4: This would include any prolapse that drops down more than 2 inches
How to Check for Pelvic Organ Prolapse at Home
If you haven't yet been diagnosed, it can be helpful to look for yourself to see if you see any tissue bulging, which may indicate you have a pelvic organ prolapse. While it doesn't replace a medical exam, the findings of this self-check can empower you with information about your pelvic floor that you can take back to your GYN.
What you’ll need:
- A mirror (or your phone camera)
- Personal lubricant (olive oil works, too)
- A pen and paper to take notes
When to consult your care provider first:
It's generally considered safe and easy for everyone to check themselves for pelvic organ prolapse, but if any of the following apply to you, check with your health care provider first.
- You’re pregnant
- You have a vaginal infection or active herpes lesions
- You’re earlier than 6 weeks postpartum and haven’t been cleared by your OB for vaginal penetration
- You've recently had vaginal or pelvic surgery or radiation
- You have any unexplained vaginal or rectal bleeding
During this self-check, you’ll be looking at the mobility of your pelvic tissues or how much they move and drop into the vaginal space. If you’re unable to complete the self-check due to pain or for any other reason, stop and make a note of what you felt. Reach out to a GYN or a pelvic floor PT if you find anything at all that concerns you.
Start Your Pelvic Organ Prolapse Self-Check:
When you’re ready, empty your bladder, wash your hands, and head to a space where you can feel comfortable doing this assessment. For this check, you will ideally be standing — gravity allows for a more realistic understanding of what is going on down there! Place your mirror or the camera on your cell phone on the floor between your legs. If you need a closer look, kneeling tall on your knees over your mirror is the next best position.
Begin by using the mirror to visualize, and get familiar with your anatomy. Open up the labia majora to get a better view of the more internal tissues. Do you notice any tissue that you don’t recognize? Do you see any tissue bulging out of your vaginal opening?
Next, keeping the labial tissues open, use your mirror to visualize your vaginal opening. Try to bulge your pelvic floor, or bear down like you’re having a bowel movement. Do you see any bulging of tissue towards the vaginal opening? If you see a couple of bulges, more like a snowman make note of this as well.
Now, place a little bit of lubricant on a clean (or gloved) finger, then fully insert your finger into your vaginal opening. Insertion of your finger should be pain-free, so if this causes any pain or discomfort, stop your pelvic floor check and instead check in with your doctor or pelvic floor PT so they can help you determine what could be causing your pain. Again, try to bulge your pelvic floor, or bear down like you’re having a bowel movement, as you did earlier. Do you feel any bulging of your vaginal walls, into your finger?
If you answered yes to the above question, try to determine if the tissue bulging out is coming from the back side of the vagina near the rectum, from the front of the vagina near the urethra, or from up above down onto your fingertip.
Make a note of your answers and everything you observed during your self-check. Again, this is not meant to diagnose a pelvic organ prolapse, but it will provide you with information that you can bring to your gynecologist or pelvic floor PT. For a more complete pelvic floor self-check that can reveal other types of dysfunction, check out this guide.
When to See a Pelvic Floor PT
If you think you might have pelvic organ prolapse — or have already been diagnosed and want to start feeling better — see a pelvic floor physical therapist sooner rather than later.
Physical therapy treatment for pelvic organ prolapse usually involves assessing and optimizing the performance of your pelvic floor, hip, and abdominal muscles. Your PT will also work on improving your bowel and bladder health to make sure your bathroom habits aren’t provoking your symptoms, and then work with you to learn how to better manage the pressure and strain that is placed on your pelvic organs during your daily activities. We may also suggest that you talk to your gynecologist about getting a pessary (which works a little like a sports bra to support your pelvic organs).
Don't hesitate to schedule an evaluation and start working with an Origin pelvic floor PT. We're here for you!