Pelvic Organ Prolapse: What Does Prolapse Feel Like and What Can You Do About It?
Pelvic organ prolapse can sound frightening when you're first diagnosed, but there are a range of management options available, and having a prolapse doesn't automatically mean you'll need surgery.
Pelvic organ prolapse (POP) occurs when one or more of the pelvic organs descend towards or into the vagina due to changes in their supporting muscles and connective tissues.
Some people experience noticeable heaviness, pressure or a vaginal bulge, while others have very few symptoms and only discover a prolapse during an examination.
Understanding what type of prolapse you have, your symptoms and how it's affecting your life can help guide the most appropriate management.
Pelvic organ prolapse can involve different areas of the vagina and pelvic organs.
Common types include:
Anterior vaginal wall prolapse – the front wall of the vagina descends, often involving the bladder. You may also hear this referred to as a cystocele.
Posterior vaginal wall prolapse – the back wall of the vagina descends, which may involve the rectum. This is sometimes called a rectocele.
Uterine prolapse – the uterus and cervix descend lower into the vaginal canal.
Vaginal vault prolapse – the upper part of the vagina descends following a hysterectomy.
It is also possible to have more than one type of prolapse at the same time.
What Are the Different Types of Pelvic Organ Prolapse?
Prolapse can feel different from person to person.
Symptoms may include:
Vaginal heaviness or pressure
A dragging sensation through the pelvis
Feeling or seeing a vaginal bulge
Feeling like something is “coming down”
Symptoms that become more noticeable later in the day
Heaviness after prolonged standing or physical activity
Difficulty completely emptying the bladder
Changes in urinary symptoms
Difficulty emptying the bowels
Needing to press around the vagina to assist a bowel motion
Discomfort during some activities or intercourse
The severity of someone's symptoms doesn't always correspond directly with the grade of their prolapse. How you feel and what you want to be able to do are important parts of management.
What Does Pelvic Organ Prolapse Feel Like?
Prolapse usually develops due to a combination of factors rather than one single cause.
Factors that may increase the likelihood of prolapse include:
Pregnancy and childbirth
Vaginal birth
Changes to pelvic floor muscles and connective tissues
Increasing age
Perimenopause and menopause
Chronic constipation and repeated straining
Chronic coughing
Regular heavy lifting
Higher body weight
Previous pelvic surgery
Family history and connective tissue factors
Having one or more risk factors does not necessarily mean you will develop symptomatic prolapse.
What Causes Pelvic Organ Prolapse?
Changes in vaginal support can occur following pregnancy and childbirth, particularly in the earlier postpartum period while the body continues to recover.
Some people notice vaginal heaviness, pressure or a bulging sensation after having a baby, particularly when they increase their activity or return to exercise.
If you're experiencing these symptoms, a pelvic health assessment can help determine what may be happening and guide your postpartum rehabilitation.
Is Prolapse Normal After Having a Baby?
Not necessarily.
Prolapse symptoms and support can change over time, and progression is not inevitable.
Symptoms can also fluctuate. Some people notice more heaviness after being on their feet for a long time, exercising, lifting, becoming constipated or during certain stages of their menstrual cycle.
Rather than assuming that prolapse will continue to worsen, management should consider your symptoms, stage of life, activities and individual risk factors.
Does Pelvic Organ Prolapse Get Worse?
Can Pelvic Organ Prolapse Get Better?
Symptoms can improve for some people with conservative management, particularly when contributing factors are identified and addressed.
Depending on your individual presentation, management may include pelvic floor rehabilitation, bowel management, modifying or gradually progressing exercise, pressure-management strategies and/or a vaginal pessary.
The aim isn't necessarily to make your anatomy “perfect”. For many people, the goal is to reduce symptoms and allow them to comfortably participate in the activities that matter to them.
Can I Exercise With a Prolapse?
Having a prolapse does not automatically mean you need to stop exercising.
Exercise is important for overall health, and the type and amount of activity someone can comfortably perform will vary considerably.
Rather than having a universal list of exercises that are “bad for prolapse”, it can be more useful to consider:
Your symptoms during and after exercise
Your current strength and conditioning
Breathing and pressure management
The loads you're working with
Your pelvic floor function
How quickly you're progressing your exercise
Your individual goals
For some people, pelvic health rehabilitation can help them gradually return to activities such as gym training, running or sport.
Does Prolapse Mean I Need Surgery?
No. Surgery is one management option for pelvic organ prolapse, but it isn't the only option.
Depending on your symptoms and individual circumstances, conservative management may include:
Pelvic floor rehabilitation
Education and symptom-management strategies
Addressing constipation and straining
Exercise modification and progression
Managing contributing factors such as chronic coughing
Vaginal pessary support
Some people manage their prolapse conservatively for many years, while others may eventually choose to discuss surgical options with a urogynaecologist or gynaecologist.
The appropriate approach depends on your symptoms, goals, medical history and preferences.
What Is a Vaginal Pessary?
A vaginal pessary is a removable medical device placed inside the vagina to provide mechanical support for pelvic organ prolapse.
There are many different shapes and sizes of pessaries, and finding the right option depends on your anatomy, type of prolapse, symptoms and lifestyle.
When appropriately fitted, many people are not particularly aware of their pessary during everyday activities.
A pessary can be used in different ways. For some people it forms part of longer-term prolapse management, while others may use one temporarily or for particular activities where they would like additional support.
Can a Pessary Help Me Exercise With Prolapse?
For some people, a pessary can provide additional support during activities that tend to bring on prolapse symptoms.
This may include walking, running, gym training, sport, prolonged standing or other physically demanding activities.
Some people choose to use their pessary primarily during exercise, while others prefer more regular use.
A pessary fitting allows you to discuss your symptoms and goals and trial an appropriate pessary to determine whether it is comfortable and useful for you.
Can Constipation Make Prolapse Worse?
Constipation and repeated straining can increase pressure through the pelvic floor and may aggravate prolapse symptoms.
If you regularly strain, experience hard stools, have difficulty completely emptying or need to use your fingers to assist bowel movements, addressing your bowel function can be an important part of prolapse management.
How Can Pelvic Health Care Help With Prolapse?
A pelvic health assessment can help determine the type and extent of prolapse present and, importantly, understand how it is affecting you.
Depending on your presentation, assessment and management may consider:
Pelvic floor strength, endurance, coordination and relaxation
Your prolapse symptoms
Bladder and bowel function
Constipation and straining
Exercise and physical activity
Breathing and pressure management
Pregnancy and birth history
Menopause and hormonal factors
Your work and everyday physical demands
Vaginal pessary fitting where appropriate
Management is tailored to your symptoms and goals, rather than your prolapse grade alone.
If you're experiencing vaginal heaviness, pressure, a bulging sensation or changes in your bladder or bowel function, it's worth discussing your symptoms with a healthcare professional.
You don't need to wait until a prolapse becomes severe before seeking assessment.
Seek medical advice for symptoms such as unexplained vaginal bleeding, significant pelvic pain, difficulty passing urine, recurrent urinary infections or other new or concerning pelvic symptoms.
When Should I Seek Help for Pelvic Organ Prolapse?
Pelvic Organ Prolapse Care in Healesville & the Yarra Valley
At Yarra Valley Women's Health, our pelvic health osteopaths provide individualised prolapse assessment and conservative management, including pelvic floor rehabilitation, education, exercise guidance and vaginal pessary fitting where appropriate.
Our goal is to give you the knowledge and options to feel informed and empowered in decisions about your pelvic health, while helping you continue participating in the activities that matter to you.