Organ descent (pelvic organ prolapse)

Other names for organ prolapse

• Pelvic prolapse
• Genital prolapse
• Bladder prolapse (cystocele)
• Descent of the rectum (rectocele)
• Descent of the uterus (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 composed of several layers of muscles and connective tissue that form a sort of hammock at the bottom of the pelvis. These structures support the bladder, uterus, and rectum, while allowing the urethra, vagina, and rectum to pass through.

Approximately 40% of women aged 50 and over will experience some form of organ prolapse. Bladder prolapse (cystocele) is the most common. Younger women can also be affected, particularly after one or more childbirths.

Organ prolapse is not dangerous to health, but it can significantly affect quality of life. Some women are asymptomatic, while others experience significant symptoms on a daily basis.

What are the different types of organ prolapse?

There are four main types of pelvic prolapse. Cystocele (bladder descent) is the most common. Rectocele affects the rectum, hysterocele affects the uterus, and enterocele affects the small intestine. Several types can coexist in the same person.

Prolapse grading system

Healthcare professionals use a grading system to assess severity:

What causes organ prolapse?

Organ prolapse occurs when the supporting tissues (muscles, ligaments) weaken or become damaged. The main causes are pregnancy, vaginal delivery, menopause, and aging. Repeated straining and certain medical conditions also increase the risk.

• Pregnancy and vaginal delivery: The stretching of tissues during pregnancy and the passage of the baby can damage the muscles and nerves of the pelvic floor.
• Aging: Tissues naturally lose their elasticity and strength with age.
• Menopause: Decreased estrogen affects the quality of supporting tissues
• Chronic constipation: Repeated straining increases pressure on the pelvic floor.
• Chronic cough: Repeated abdominal pressure weakens the supporting structures
• Pelvic surgeries: A hysterectomy can affect the supporting structures
• Connective tissue disorders: Ehlers-Danlos syndrome or Marfan syndrome increases the risk

What are the risk factors?

Some women are at greater risk of developing pelvic prolapse. Advanced age, multiple births, obesity, and chronic constipation are important factors.

What are the symptoms of organ prolapse?

The main symptom is a feeling of heaviness or pressure in the vagina, as if something were falling down. Other signs include urinary or bowel difficulties, a feeling of a lump in the vagina, lower back pain, and discomfort during sexual intercourse.

• Feeling of heaviness or pressure in the vagina
• Feeling that something is coming down or out of the vagina
• Visible or palpable lump at the entrance to the vagina
• Difficulty urinating or completely emptying the bladder
• Urinary leakage (incontinence)
• Constipation or difficulty passing stool
• Need to support the perineum when having a bowel movement
• Lower back pain
• Discomfort or pain during sexual intercourse

• At the end of the day
• After prolonged standing
• During physical activities
• During pushing efforts

Some women experience no symptoms, especially when the prolapse is mild.

How is organ prolapse diagnosed?

The diagnosis is made through a pelvic physical examination performed by a healthcare professional. The perineal rehabilitation physiotherapist or doctor visually and manually assesses the degree of prolapse. Additional tests are rarely necessary.

• Medical history: Questions about your symptoms, pregnancies, deliveries, and lifestyle habits
• Physical examination: Visual and manual assessment of the vagina and perineum
• Push test: You are asked to push to observe the behavior of the organs.
• Muscle assessment: Testing the strength and coordination of your pelvic muscles

Imaging tests (ultrasound, MRI) are sometimes prescribed in complex cases, but a clinical examination is usually sufficient to establish the diagnosis.

How does perineal physiotherapy help?

Perineal 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 degree of prolapse with this treatment.

A randomized clinical trial showed that 17% of women who followed a pelvic floor strengthening program for 6 months 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 physical therapist will evaluate

Treatments offered

Based on the results of the assessment, your physical therapist will be able to:

• Teaching you pelvic floor strengthening exercises
• Show you the "perineal lock" technique before straining
• Correct your posture and breathing
• Providing you with advice on managing abdominal pressure
• Mobilize tissues if necessary
• Using biofeedback to improve muscle awareness

What is a pessary and when should it be used?

A pessary is a silicone device placed in the vagina to support prolapsed organs. It can be used daily or occasionally for certain activities. It is an effective non-surgical option when rehabilitation alone is not sufficient.

• Non-surgical and reversible solution
• Can be removed and reinserted by the patient
• Allows daily activities to continue
• Satisfaction rate of 70 to 90%

The pessary is fitted by a trained professional (physical therapist or doctor) and requires regular follow-up visits.

When should you see a physical therapist?

Consult a perineal 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.

• Feel heaviness or pressure in the vagina
• Feel like something is coming down
• Experiencing urinary or bowel difficulties
• Do you have urinary incontinence?
• Feel discomfort during sexual intercourse

• After a vaginal delivery
• At menopause
• If you have multiple risk factors
• Before or after pelvic surgery

You do not need to see a doctor before consulting a physical therapist. If your condition requires further medical evaluation, your physical therapist will refer you.

What can you do at home to relieve symptoms?

Several home remedies can relieve the symptoms of prolapse. Lie down with your pelvis elevated for immediate relief. Use a small stool on the toilet to make it easier to pass stool. Avoid straining and manage constipation.

To relieve the feeling of heaviness

• Lie on your back with your pelvis raised on one or two pillows.
• The hips should be slightly higher than the shoulders.
• This position helps the organs move upward by gravity.

To ease bowel movements

• Place your feet on a small stool in front of the toilet.
• Keep your knees higher than your hips.
• Lean forward slightly.
• Avoid pushing hard

Habits to adopt

What is the recovery time?

Most women see an improvement in symptoms within 3 to 6 months of regular perineal rehabilitation. Strengthening the pelvic floor requires consistency. Exercises often need to be maintained over the long term to maintain the benefits.

• The initial grade of prolapse
• Regularity of exercise
• Adherence to recommendations
• Participation in supervised sessions

Studies show that training supervised by a physical therapist is more effective than written instructions alone. A personalized program and regular follow-up optimize your chances of improvement.

If conservative treatments are not sufficient, your physical therapist will discuss other options with you, including a pessary or referral for surgery.

To learn more

You can listen to the podcast "Parle-moi de santé" (Talk to me about health) produced by one of our physical therapists, Alexis Gougeon. Episode #23 discusses perineal and pelvic rehabilitation with Jennifer Lévesque.

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.