Pelvic Organ Prolapse: Causes, Symptoms, Treatment Options
Pelvic organ prolapse (POP) is a common yet often misunderstood condition affecting millions of women worldwide. While it can significantly impact quality of life, causing symptoms like discomfort, pressure, and urinary or bowel challenges, many women suffer in silence due to stigma or lack of awareness.
Dr. Nahla Merhi, gynecologist and urogynecologist with the Midwest Institute for Robotic Surgery at Silver Cross Hospital, offers helpful information about the condition, including causes, risk factors, symptoms, and treatment options for pelvic organ prolapse—thus empowering women with the knowledge to seek help and regain control over their well-being.
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when the muscles and tissues supporting the pelvic organs weaken, causing one or more organs—such as the bladder, uterus, or rectum—to drop or press against the vaginal wall. The condition is more common than many women realize, affecting approximately one in four women over 40 and increasing with age. By age 50, the prevalence rises to one in three women experiencing some form of prolapse.
“Many patients suffer from it, but silently. Instead of addressing the issue with their doctor, many women are embarrassed to talk about it, or sometimes they're scared they maybe need a big surgical procedure. That's the reason patients go without treatment. And they shouldn't, because it can affect their life every single day,” states Dr. Merhi.
What Causes Pelvic Organ Prolapse?
Pelvic organ prolapse can result from various factors, including childbirth, difficult vaginal deliveries, heavy lifting, or jobs requiring excessive physical strain. Some women without children also experience prolapse due to genetics, chronic coughing, being overweight, or other conditions that weaken the pelvic floor over time. The effects often manifest years after the initial cause, with many women noticing prolapse symptoms decades after childbirth or other contributing events.
The condition often presents as a noticeable bulge at the vaginal opening, causing discomfort and difficulty sitting, walking, or even performing basic functions like emptying the bladder or bowels. In severe cases, the prolapse may protrude completely outside the body, significantly impacting daily life, including intimacy. It is frequently associated with urinary or stool incontinence, as these issues often occur together, highlighting the interconnected nature of prolapse and pelvic floor dysfunction.
“It is not a killer, but guess what? It is always life altering,” shares Dr. Merhi. “Some women stop having social gatherings, stop going to their church or meeting up with their friends. They're embarrassed if they have incontinence, if somebody is smelling that incontinence, whether it is urine or stool. Some women stop having any physical, sexual intimacy with their partners. It could be depressing. It is depressing.”
Treatment Options
Treatment for pelvic organ prolapse depends on its severity. Mild cases are often managed with pelvic floor exercises and physical therapy, such as Kegel exercises, to strengthen the muscles and support the pelvic organs. Moderate prolapses may require a minimally invasive, outpatient transvaginal surgery to repair torn tissues with stitches.
For advanced prolapse, where organs are significantly displaced, a more robust approach is needed. This involves robotic hernia repair using a hernia mesh—distinct from FDA-warned vaginal meshes—to securely lift and support the organs. This outpatient procedure requires small abdominal incisions, resulting in minimal pain and a fast recovery, with many patients resuming normal activities within days.
“The pain, surprisingly, is so minimal that patients come back after their first visit saying, ‘I'm shocked. I needed only two days of pain medications.’ Some patients don't even take narcotics for that,” notes Dr. Merhi. “Most patients say, ‘Why did I even wait? I should have come way, way sooner. I should not have suffered. It wasn't bad. I'm going to tell all my friends.’ That's why we're getting busy. And that's a good problem.”
Dr. Merhi urges anyone dealing with pelvic organ prolapse to seek out professional help sooner rather than later. Doing so leads to better treatment outcomes and significant reduction of symptoms.
