Pelvic Organ Prolapse
Pelvic prolapse, commonly known as organ descent, is when one or more pelvic organs (e.g., bladder, urethra, uterus, rectum, and colon) drop into the vaginal canal. Approximately 40% of women aged 50 and over will experience organ descent, but younger women can also be affected. Bladder prolapse is the most common.
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Other names for organ prolapse
- Pelvic prolapse
- Genital prolapse
- Bladder prolapse (cystocele)
- Rectal prolapse (rectocele)
- Uterine prolapse (hysterocele)
What is organ prolapse (pelvic prolapse)?
Organ prolapse is the descent of one or more pelvic organs (bladder, uterus, rectum) into the vaginal canal. This condition occurs when the muscles and ligaments of the pelvic floor weaken and can no longer adequately support these organs.
The pelvic floor is made up of several layers of muscles and connective tissues that form a hammock-like structure at the bottom of the pelvis. These structures support the bladder, uterus, and rectum, while also allowing the passage of the urethra, vagina, and rectum.
Approximately 40% of women aged 50 and older will experience some form of organ prolapse. Bladder prolapse (cystocele) is the most common. Younger women can also be affected, especially after one or more childbirths.
Organ prolapse is not dangerous to your health, but it can significantly impact your quality of life. Some women experience no symptoms, while others have significant daily symptoms.
What are the types of organ prolapse?
There are four main types of pelvic prolapse. Cystocele (bladder prolapse) is the most common. Rectocele involves the rectum, hysterocele involves the uterus, and enterocele involves the small intestine. Several types can coexist in the same person.
| Type | Organ affected | Description |
|---|---|---|
| Cystocele | Bladder | The bladder descends into the front wall of the vagina |
| Rectocele | Rectum | The rectum bulges into the back wall of the vagina |
| Hysterocele | Uterus | The uterus descends into the vaginal canal |
| Enterocele | Small intestine | The small intestine protrudes into the upper part of the vagina |
Prolapse Grading System
Healthcare professionals use a grading system to assess severity:
| Grade | Severity | Description |
|---|---|---|
| Grade 1 | Mild | The organ slightly descends into the vagina |
| Grade 2 | Moderate | The organ reaches the vaginal opening |
| Grade 3 | Advanced | The organ extends past the vaginal opening |
| Grade 4 | Complete | The organ completely exits the vagina |
What causes organ prolapse?
Organ prolapse occurs when the supporting tissues (muscles, ligaments) weaken or become damaged. The main causes include pregnancy, vaginal childbirth, menopause, and aging. Repeated straining and certain medical conditions also increase the risk.
Main causes:- Pregnancy and Vaginal Childbirth: The stretching of tissues during pregnancy and the baby's passage can damage the pelvic floor muscles and nerves.
- Aging: Tissues naturally lose elasticity and strength with age.
- Menopause: Decreased estrogen levels affect the quality of supporting tissues.
- Chronic Constipation: Repeated straining increases pressure on the pelvic floor.
- Chronic Cough: Repeated abdominal pressure weakens supporting structures.
- Pelvic Surgeries: A hysterectomy can affect supporting structures.
- Connective Tissue Disorders: Conditions like Ehlers-Danlos or Marfan syndrome increase the risk.
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What are the risk factors?
Some women are at higher risk of developing pelvic prolapse. Advanced age, multiple childbirths, obesity, and chronic constipation are important factors.
| Risk factor | Impact |
|---|---|
| Over 50 years of age | Increased risk |
| Multiple vaginal births | Significantly increased risk |
| Menopause | Increased risk (due to lower estrogen levels) |
| Overweight or obesity | Increased abdominal pressure |
| Chronic constipation | Repeated strain on the pelvic floor |
| Chronic cough | Repeated abdominal pressure |
| Lifting heavy loads | Stress on the pelvic floor |
| Family history | Genetic predisposition |
Good to know: Having risk factors does not mean you will develop prolapse. Prevention and pelvic floor rehabilitation can significantly reduce this risk.
What are the symptoms of organ prolapse?
The main symptom is a feeling of heaviness or pressure in the vagina, as if something is descending. Other signs include urinary or bowel difficulties, a sensation of a lump in the vagina, lower back pain, and discomfort during sexual intercourse.
Most common symptoms:- Feeling of heaviness or pressure in the vagina
- Sensation that something is descending or coming out of the vagina
- Visible or palpable lump at the entrance of the vagina
- Difficulty urinating or completely emptying the bladder
- Urinary leakage (incontinence)
- Constipation or difficulty emptying your bowels
- Needing to support your perineum to have a bowel movement
- Lower back pain
- Discomfort or pain during sexual intercourse
- At the end of the day
- After standing for a long time
- During physical activities
- During straining or pushing efforts
Some women experience no symptoms, especially when the prolapse is mild.
How is organ prolapse diagnosed?
Diagnosis involves a pelvic physical exam performed by a healthcare professional. A pelvic floor physiotherapist or doctor will visually and manually assess the degree of prolapse. Additional tests are rarely needed.
Evaluation steps:- Medical history: Questions about your symptoms, pregnancies, deliveries, and lifestyle habits
- Physical exam: Visual and manual assessment of the vagina and perineum
- Pushing test: You will be asked to push to observe how the organs move
- Muscle assessment: Testing the strength and coordination of your pelvic muscles
Imaging tests (ultrasound, MRI) are sometimes prescribed for complex cases, but a clinical exam is usually enough to make a diagnosis.
How does pelvic floor physiotherapy help?
Pelvic floor physiotherapy is the first-line treatment for pelvic prolapse. It strengthens the pelvic floor muscles, improves organ support, and reduces symptoms. Studies show a significant reduction in the prolapse grade with this treatment.
A randomized clinical study showed that 17% of women who completed a 6-month pelvic floor strengthening program saw their prolapse improve by at least one grade. Participants also reported a significant reduction in their symptoms and an improved quality of life.
What your physiotherapist will assess
| Aspect evaluated | Goal |
|---|---|
| Lifestyle habits | Identify aggravating factors |
| Posture and breathing | Assess pressure management |
| Pelvic muscle strength | Measure support capacity |
| Muscle coordination | Check contraction timing |
| Effort technique | Observe pressure management |
Recommended treatments
Based on the assessment results, your physiotherapist will be able to:
- Teaching you pelvic floor strengthening exercises
- Showing you the "perineal lock" technique to use before straining
- Correcting your posture and breathing
- Giving you advice on managing abdominal pressure
- Mobilize tissues if necessary
- Use biofeedback to improve muscle awareness
What is a pessary and when should you use one?
A pessary is a silicone device placed in the vagina to support prolapsed organs. It can be used daily or occasionally for specific activities. It's an effective non-surgical option when rehabilitation alone isn't enough.
| Pessary type | Shape | Usage |
|---|---|---|
| Ring | Donut | Most common, easy to manage yourself |
| Gellhorn | Mushroom | More advanced prolapses |
| Cube | Cubic | Occasional use, specific activities |
- Non-surgical and reversible solution
- Can be removed and reinserted by the patient
- Helps maintain daily activities
- 70 to 90% satisfaction rate
A trained professional (physiotherapist or doctor) adjusts the pessary, and regular follow-ups are required.
When to consult a physiotherapist?
Consult a pelvic floor physiotherapist if you experience symptoms of prolapse or have risk factors. You do not need a medical referral. Preventive consultation is also recommended, especially after childbirth or during menopause.
Consult if you:- Feel a heaviness or pressure in the vagina
- Feel like something is descending
- Experience urinary or bowel difficulties
- Have urinary leaks
- Experience discomfort during sexual intercourse
- After a vaginal delivery
- During menopause
- If you have multiple risk factors
- Before or after pelvic surgery
You do not need to see a doctor before consulting a physiotherapist. If your condition requires further medical evaluation, your physiotherapist will guide you.
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Book an appointmentWhat to do at home to relieve symptoms?
Several home strategies can relieve prolapse symptoms. Lie down with your pelvis elevated for immediate relief. Use a small stool in the restroom to help with bowel movements. Avoid straining and manage constipation.
To relieve the feeling of heaviness
- Lie on your back with your pelvis elevated on one or two cushions
- Your hips should be slightly higher than your shoulders
- This position uses gravity to help your organs move back into place.
To make bowel movements easier
- Place your feet on a small stool in front of the toilet
- Keep your knees higher than your hips
- Lean slightly forward
- Avoid straining
Habits to adopt
| To Do | To avoid |
|---|---|
| Drink enough water | Hold back your stool |
| Eat fiber | Lift heavy loads |
| Doing your pelvic floor exercises | Straining hard during bowel movements |
| Maintain a healthy weight | Standing for long periods without a break |
What is the recovery time?
Most women notice an improvement in symptoms within 3 to 6 months of consistent pelvic floor rehabilitation. Strengthening your pelvic floor requires dedication. Exercises often need to be continued long-term to maintain the benefits.
Factors influencing recovery:- The initial stage of prolapse
- The consistency of your exercises
- Following the recommendations
- Participation in supervised sessions
Studies show that supervised training with a physiotherapist is more effective than relying solely on written instructions. A personalized program and regular follow-up greatly improve your chances of getting better.
If conservative treatments are not enough, your physiotherapist will discuss other options with you, such as a pessary or a referral for surgery.
To learn more
You can listen to the podcast "Parle-moi de santé," created by one of our physiotherapists, Alexis Gougeon. Episode #23 features Jennifer Lévesque discussing perineal and pelvic rehabilitation.
Find the episode on YouTube, Spotify or Apple Podcasts.
Sources
- Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311-1316.
- Braekken IH, Majida M, Engh ME, Bø K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. 2010;203(2):170.e1-7.
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