Got POP? Demystifying pelvic organ prolapse

The following is written by Dr. Sinéad Dufour PhD. We are fortunate to have the opportunity to collaborate with Dr. Sinead Dufour, who is a Researcher (PhD) of all things Pelvic Health. She is also a Pelvic Health Physiotherapist in Burlington and Oakville, a Professor and lecturer at McMaster University, and on the teaching faculty of Bia Formation and Reframe Rehab and Pelvic Health Solutions. Dr. Sinead Dufour is also the sister of the founder of Compass Rose Wellness, and is a huge supporter in developing more resources and access for women’s healthcare. It was with her encouragement and assistance finding a top notch Pelvic Health Physiotherapy team, that Compass Rose Wellness Centre was opened in 2020.

Maybe it’s just us, but there’s something about the word “prolapse” that brings to mind utter calamity. When you hear it you might picture a building toppling or a bridge disintegrating. While it’s true that prolapse has to do with your organs shifting out of place, humans aren’t architecture. Your pelvic floor is not an overloaded balcony at a frat party.

First things first. If you suspect that you might be experiencing a prolapse of one of your pelvic organs, take a deep breath. You need to understand that pelvic organ prolapse (POP) is extremely common—even more so than urinary incontinence—so you’re not alone, and better yet, there are a wide variety of treatment options to explore(and that really work).
For more about the anatomy involved and how to keep it healthy, read Get to know your pelvis. Now, let’s talk about prolapse!

What is POP?

Pelvic organ prolapse is simply the condition where one of your three pelvic organs (the bladder, uterus, or rectum) begins to descend, essentially moving out of place. These organs are all supported by the muscle systems of the pelvis, primarily the pelvic floor. If you have a lack of fitness in your pelvic floor (which could be caused by age, childbirth, or a general lack of physical fitness—but is not hereditary), one or more of these organs could begin to “drop” or “descend” down into the vagina.

Yes, you read that right but it’s neither as dire nor mystifying as it sounds. The pelvic floor supports your organs from the bottom while fascia holds them up from the top. So, if your pelvic floor is not working so well, and it’s not addressed, the soft tissue that holds the organs from the top can give out over time. This is POP.

Symptoms of pelvic organ prolapse

There are many symptoms that could refer to POP.  The most common one is the feeling of pressure in the pelvis, particularly at the end of the day.  Others might include urinary incontinence, incomplete urinary emptying (just a fancy way of describing when you pee and a bit more comes out after you stand up), or trouble having a bowel movement. When POP is further along, you might experience more severe (and frightening) symptoms like tissue protruding from your vagina.
But there’s good news, and lots of it. First of all, the severity of your symptomatic sensations may not relate directly to the severity of your pelvic floor health issue. In other words, even though you feel like you’re sitting on a tennis ball doesn’t mean you have a severe prolapse. This is one of those areas when people’s individual bodies and experiences really make a difference. Secondly, there are lots of treatment (and prevention!) options. Let’s go there now.

What you can do about prolapse

The very first thing you need to do is speak with (and yes, be examined by) a pelvic floor health specialist. This is not only going to give you some solid information on your specific pelvic health but it will also give the specialist what they need to design a treatment plan.
So what about those treatments?

Lifestyle modification

Ugh, we know! Not only are so-called “lifestyle changes” vague—and vaguely intimidating—they’re also super annoying to try and implement. Nonetheless, a healthy diet, sufficient sleep, and a good deal of the right exercise, including pelvic floor exercise, will keep your pelvic organs health and happy.

Pelvic floor muscle training (PFMT)

Let us guess—you’re thinking about Kegels. The truth is, Kegels are a kind of PFMT but they aren’t the only kind. Different exercises and associated breathing patterns are used to promote pelvic floor health and a health care provider with specific training in this area can help design a program for your specific body and issue.

Prolapse pessary

This is a fairly unobtrusive intervention by way of a silicone device that you wear inside your vagina. These devices support the organ while correcting its position and take strain off the soft tissue that holds the organs up. It is also much easier to train your pelvic floor when you don’t have an organ sitting on it so there are many reasons to consider a pessary. However, for some women the idea of having a device inside is a no-go, so it’s not for everyone.

While surgery is also a treatment for prolapse, we together with our partners who are urogynecologists (the surgeons who do prolapse surgery) believe it should only be considered after these conservative options have been tried as they’re safer and very effective. Surgery is invasive and not terribly effective in some cases so it’s not a medically recommended first option.