Pelvic Organ Prolapse

A pelvic organ prolapse or POP is a term used to describe the protrusion of pelvic organs such as the uterus, bladder, rectum, or small intestine into the vagina. The vagina is essentially a ‘covering of skin’ of these organs.

What you are feeling when you feel the bulge is the protrusion of vaginal skin, with the respective organs behind the vaginal walls. These organs are never actually exposed to the outside.

The degree of the prolapse may vary from a small drop of either the anterior or posterior walls to a complete protrusion of the cervix outside of the vagina. 

There are different terms used to describe the part of the organ that is sagging:

• Cystocele refers to bladder prolapsing into vagina
• Rectocele refers to rectum prolapsing into vagina 
• Enterocele refers to small intestines prolapsing into vagina, especially if you have had previous uterine removal (hysterectomy)
• Uterine prolapse refers to uterus prolapsing into vagina
• Vaginal vault prolapse refers to the top of the vagina prolapsing down into the vagina

What causes a prolapse?

When the muscles, nerves and connective tissues that support your pelvic region are injured, they can weaken or stop working. These injuries can be due to many factors. Sometimes it can be genetic, however other factors that contribute include:

• Increasing number of pregnancies and deliveries
• Vaginal childbirth that over-stretches the muscles and tissue of the pelvic floor. This is especially following forceps delivery or with larger babies
• A long-term strain that includes pressure from obesity or constipation

What are the symptoms of pelvic organ prolapse?

• The sensation of a vaginal lump/bulge protruding into or out of vagina
• Chronic fullness, pressure, or aching in the pelvis
• Heavy, dragging lower pelvic or back discomfort
• Incontinence or problems with urinary or bowel function
• Difficulty passing urine or bowel motions, which may occasionally require pushing on the bulge to help with evacuation
• Discomfort or difficulty inserting tampons
• Pain or discomfort with sexual intercourse

How can a prolapse be diagnosed?

A thorough consultation and a comprehensive physical examination is very important to determine the extent of the condition. To complement this, Dr Wong may request further investigations including urodynamics study or pelvic floor ultrasound to gain an in-depth understanding of your condition.

Treatment options

There are various treatment options for prolapse. Some women start with a more conservative treatment approach, however Dr Wong will always tailor her management plan in consultation with you to ensure that you receive the best results.

For more information on the surgical options for pelvic organ prolapse, click here.