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What's that Bulge? It Could Be Pelvic Organ Prolapse

March 7, 2023

A strong pelvic floor doesn’t just take your orgasm to the next level—the muscles and ligaments literally hold your pelvic organs in place and prevent them from sinking in your pelvis. If these pelvic muscles weaken, one or more of these organs can droop down and appear to “bulge” out of the vagina. This is known as a pelvic organ prolapse, or POP, and is more easily diagnosed than other chronic pelvic pain conditions, as it’s usually accompanied by feeling or seeing an uncomfortable bulge in the vagina.

Pelvic organ prolapse can affect your reproductive organs including your vagina, cervix, and uterus, but it can also affect other organs in your pelvis including your bladder, urethra, rectum, and anus, making this condition even more taboo to discuss. So naturally, we want to talk about it.

What Causes Pelvic Organ Prolapse?

To put it simply, pelvic organ prolapse is caused by weakened pelvic floor muscles, which causes one or more of the pelvic organs to literally fall downward into or even out of the vagina or anus. While chronic pelvic pain conditions don’t discriminate, and can affect anyone of any age, race, gender, or weight, people with periods are at greater risk for developing POP if they are white or Hispanic, going through menopause, overweight, or have a family history of pelvic organ prolapse. Other common risk factors include:

Vaginal childbirth, which can stretch and strain the pelvic floor. Multiple vaginal childbirths increase your risk for pelvic organ prolapse later in life.
Long-term pressure on your abdomen, including pressure from being overweight, chronic coughing (from smoking or other health conditions), or straining often during bowel movements
Natural aging. Pelvic floor disorders are more common in those over the age of 60, most likely due to natural weight gain, less mobility, and other health conditions.
Loss of estrogen during and after menopause can raise your risk for pelvic organ prolapse, although researchers are not sure exactly why this happens

Pain Areas & Symptoms of Pelvic Organ Prolapse

While you may not experience symptoms in the early stages of POP, a telltale sign of a pelvic organ prolapse is a bulge at the opening of the vagina. The bulge isn't dangerous, but it can be very uncomfortable. Symptoms usually come on gradually, but in some cases, may present themselves suddenly.

There are different types of pelvic organ prolapse, depending on the pelvic organ affected. The most common types include:

A dropped bladder, or cystocele is the most common type of pelvic organ prolapse. It happens when (you guessed it) the bladder drops into or out of the vagina. This causes the ureter (the tube through which urine exits the body) to bend, which may make it difficult to empty your bladder fully, and can cause recurrent UTIs.
Rectocele happens when the rectum bulges into or out of the vagina, which can lead to constipation.
A dropped uterus, or uterine prolapse occurs when the uterus bulges into or out of the vagina.
Uterine prolapse is sometimes associated with a small bowel prolapse, or enterocele, where part of the small intestine, bulges into the vagina.
Although rare, pelvic organ prolapse can also happen after a hysterectomy, when any part of the vaginal wall drops, causing a bulge into or out of the vagina.

Common Symptoms of Pelvic Organ Prolapse

In addition to the sensation of feeling (or seeing) an uncomfortable bulge in the vagina, you may experience other symptoms such as

Pain, pressure, aching, or fullness in the pelvis and/or lower back
Pain during urination (dysuria)
Other urinary problems, like incontinence or the feeling that you need to constantly urinate
Constipation
Pain during or after sex (dyspareunia)
Trouble inserting tampons

You may notice your symptoms worsen throughout the day, during physical activity, or standing for prolonged periods of time, when gravity places extra pressure on the pelvis.

Diagnosis & Treatment of POP

If you suspect that you have a prolapse, schedule an appointment with your gynecologist, or pelvic health physiotherapist. Your doctor will ask you about your symptoms and perform a pelvic exam. You may be asked to strain or cough during the exam so your doctor can see whether these actions cause prolapse or urine leakage.

If you’re also having issues like urinary incontinence or a feeling of incomplete emptying of your bladder, your doctor may perform a procedure called a cystoscopy to examine your bladder and urethra. They may also order an ultrasound or MRI, which can help them assess your kidneys and other pelvic organs that may be affected.

Lifestyle Management

Most prolapses can be treated with pelvic floor exercises, kegels, or lifestyle changes that help strengthen the pelvic floor. Your doctor may also recommend a device called a pessary, which are usually made-to-fit removable silicone devices that are inserted into the vagina to help support the prolapsed organs.

Surgery May Be Necessary

For those who aren’t comfortable with the idea of using a pessary, or who have tried it and found it didn't relieve their symptoms, there are different types of surgery, based on the location and severity of the prolapse and other health issues. Those who are at high risk for repeated prolapse may have a procedure called sacrocolpopexy, where small incisions in the abdomen help reposition the pelvic organs. Your doctor may also use your own body tissue to build pelvic floor support. (This type of surgery used to utilize synthetic mesh to repair the prolapse through the abdomen, but because of safety issues, mesh is no longer used. If you’ve had this surgery with mesh and are experiencing symptoms such as abnormal vaginal bleeding, discharge, or pain during sex, talk with your doctor! If you don’t experience any symptoms, you likely have no need for concern.

For those who have uterine prolapse and don’t plan to have children, a hysterectomy, or removal of the uterus is often recommended. Just be aware that in rare cases, a hysterectomy may cause another pelvic organ prolapse.

If you experience symptoms that interfere with your daily life and you don’t plan to have children or penetrative vaginal intercourse, you may consider colpocleisis, which treats prolapse by closing the vaginal opening.

What it's like to live with Pelvic Organ Prolapse

Stephanie (she/her) of @barefootboymomma shares her experience of managing her pelvic organ prolapse as a 29 year old mother of two. We asked her what it's like to live with pelvic organ prolapse.

What would you recommend to someone who is trying to find the source of their discomfort?

I would say listen to your body and ask your gynecologist or other [vulva owners] in your life. We shouldn't be afraid to talk about pelvic pain with the [people] who care most about us. Get up close and personal with your vulva, use a handheld mirror and your hands and feel around down there. If you don't know what your normal looks or feels like, then it will be harder to tell what's wrong.

What products or methods have you used to help alleviate your pain?

My go to for pain relief is a heating pad and essential oils. I really like peppermint and rosemary right on my belly or in a bath. That's why I started following Momotaro. I don't like the way I feel on prescription pain medication and ibuprofen does not help me with any pelvic pain. I have just started looking into pelvic floor exercises but I'm taking it slow and waiting to see a urogynecologist to see if I can get a pelvic floor physical therapist who can tell me which exercises are right for my body.

How does chronic pain affect your day to day life?

It makes it hard to do things with my sons. They love rollerblading and I try to go with them, but the pressure and pain makes our trips shorter than they like. At 29, I feel like I should be more active, but when I'm in pain and I feel like I'm sitting on a softball I just like to stay home a lot. It has started to take its toll on my relationship as well. I feel broken some days and I don't want my fiancé to touch me. He has had to be super patient as we learn to navigate our sex life through this.

What activities often make your POP symptoms worse?

My period makes my pain so much more intense. My cervix always slips down at its lowest and it will hurt to walk or sit and I can't get comfortable for the first three or four days. Walking or sitting for too long can make the pressure build up so I try to find a balance of moving around at work and listening to my body when I need to sit and rest.

What happens if POP is left untreated?

Many people can live at stage 1 or 2 and not even know they have any problems other than maybe a little pee when they sneeze that they attribute to having children or getting older. When you get to stages 3 and 4, it can make it harder to pull everything back in. Sometimes you will need a hysterectomy, which is the road I might be heading down soon. There are surgeries that use mesh to repair the connective tissue and those have their own risks like erosion of the mesh or infection. Some women opt for a pessary, which is a silicone device used to hold everything in place. Some can be placed on their own and some require a visit to your doctor for removal and cleaning.

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