Pelvic organ prolapse

Pelvic organ prolapse, or POP, is the dropping of the pelvic organs caused by the loss of normal support of the vagina.

POP occurs when there is weakness or damage to the normal support of the pelvic floor. The pelvic floor holds up the pelvic organs, including the vagina, cervix, uterus, bladder, urethra, intestines and rectum. If the muscles of the pelvic floor and layers of connective tissue, which are called fascia, become weakened, stretched, or are torn the pelvic organs may fall downward. The organs drop down from where they should be and can cause trouble. In severe cases, women may feel or see tissue coming out of the opening of their vagina. Typically, the tissue coming out is from a prolapsing cervix and uterus or the walls of the vagina.

Am I at Risk?

Pelvic organ prolapse is common in women. The incidence increases after childbearing and as women increase in age.

Childbirth (vaginal or operative vaginal delivery) can cause injury to the muscles or fascia of the pelvic floor. The increased pressure of childbirth on the internal organs in the abdomen can lead to POP. Operative vaginal deliveries (forceps or vacuum deliveries) may also increase the risk of pelvic floor injury and increase a woman’s risk of developing prolapse. Route of delivery is a very important and complicated topic—discuss the risks and benefits with your doctor.

Though pregnancy and vaginal birth does contribute to the development of pelvic floor disorders, there are women who have delivered many times who never developed prolapse. And, others who have never been pregnant who leak urine and stool. Risk factors, which predispose, cause, promote, or worsen pelvic organ prolapse, include:

Genetics

• POP is a hereditary disorder, meaning that it runs in families. Our genes influence the strength of our bones, muscles and connective tissue. Some women are born with weaker tissues and are a higher risk for prolapse.
• Caucasian women are more likely than African American women to develop pelvic organ prolapse.

Lifestyle

• Smoking increases your risk of developing POP.

Pelvic Floor Injury

• Injury to any part of the pelvic floor can occur during vaginal delivery, surgery, pelvic radiation, or fractures to the back and pelvis caused by falls or motor vehicle accidents.
• Hysterectomy and other procedures done to treat pelvic organ prolapse also are associated with future development of prolapse.

Other Health Conditions

• Chronic constipation and chronic straining.
• Chronic coughing.
• Obesity—obese women have a 40 to 75% increased risk of pelvic organ prolapse.
• Menopause
• Nerve and muscle diseases, which contribute to the deterioration of pelvic floor strength.
• Heavy lifting and intense repetitive activity such as CrossFit.