Pelvic organ prolapse is a common but often underdiscussed condition that affects many women, particularly after childbirth or with aging. Although it can feel uncomfortable or even embarrassing to talk about, CU Medicine urogynecologist Julie LaCombe, MD wants patients to know they don’t have to wait to seek treatment.

“Pelvic organ prolapse can affect a woman’s sense of self, her well-being and even lead to depression,” shares Dr. LaCombe.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the ligaments and connective tissues that support the pelvic organs weaken, allowing one or more organs to bulge into the anterior, posterior or top of the vaginal wall.

The pelvic organs include:

• The bladder
• The uterus
• The rectum
• The small bowel

When support structures weaken, these organs can prolapse, or shift downward, creating pressure or a bulge in the vagina.

The types of pelvic organ prolapse include:

• Bladder prolapse – when the bladder bulges into the anterior vagina
• Uterine prolapse – when the cervix and uterus drop lower in the vagina
• Rectocele – when the rectum pushes on the postural wall

What Causes Pelvic Organ Prolapse?

There are many reasons for pelvic organ prolapse. Along with aging, the following risk factors for pelvic organ prolapse include:

• Genetic inheritance of  certain types of collagen, smooth muscle and elasticity cells
• Childbirth
• Menopause
• Chronic constipation
• Repeated heavy lifting
• Chronic coughing
• Previous pelvic surgery

“Pelvic organ prolapse is usually a problem related to collagen and elastin cells that help to hold up your pelvic organs,” shares Dr. LaCombe. “When the organs lose support, they can bulge, similar to a hernia.”

What are the Symptoms of Pelvic Organ Prolapse?

Pelvic organ prolapse symptoms can vary depending on the organ involved and the severity of the condition.

Common pelvic organ prolapse symptoms include:

• A feeling of pressure or heaviness in the pelvis
• A visible bulge in the vagina that a woman may also be able to feel
• Urinary leakage or difficulty emptying the bladder
• Bowel movement difficulties
• Pelvic pressure or lower back pain that may occur after increased activities
• Discomfort during intercourse

“We’ve seen patients with prolapse with symptoms and patients without any symptoms,” says Dr. LaCombe. 

What are the Stages of Pelvic Organ Prolapse?

Dr. LaCombe outlines the stages of pelvic organ prolapse below:

Stage 1: Symptoms are mild and up to 90% of women after childbirth have stage 1 pelvic organ prolapse. Most women may be unaware of a Stage I prolapse.

Stage 2: Symptoms are also mild but may include pressure and more frequent urination

Stage 3: Symptoms are more apparent and most women are aware of a change, and sometimes a bulge can be felt or seen at the opening of the vagina.

Stage 4: Symptoms are hard to ignore and include a visible bulge extending outside of the vagina.

Can Pelvic Organ Prolapse Get Worse if Left Untreated?

In short, yes. Pelvic organ prolapse can get worse if left untreated. The organs can gradually sit lower in the vagina and create more symptoms.

Beyond physical pressure, untreated prolapse may contribute to urinary and bowel incontinence, difficulty emptying your bladder or bowels, and in some cases, even become a mobility issue. Urinary incontinence is one of the leading reasons women transition to a nursing home, as it can significantly affect independence and quality of life.

“The average time it takes for women to seek care for pelvic organ prolapse is 6 years,” shares Dr. LaCombe. “Treatment can often be minimally invasive and sometimes if we can treat the main issue causing symptoms, patients can live many years without further interventions.”

How is Pelvic Organ Prolapse Treated?

Pelvic organ prolapse treatments range from non-surgical to minimally invasive procedures, to surgical options, depending on the patient’s level of prolapse and personal preferences.

Treatments for pelvic organ prolapse include:

• Pelvic floor therapy
• Non-surgical devices worn vaginally to support the uterus or vaginal walls
• A wide variety of surgical options and repairs

Many of the surgeries available for pelvic organ prolapse are minimally invasive according to Dr. LaCombe. She shares, “We do our best to get our patients recovered and doing what they want to do like playing tennis and working.”

Choosing the Right Doctor for Pelvic Organ Prolapse

Dr. LaCombe emphasizes that patients should feel comfortable and heard when discussing their health with their doctor. She shares, “Women should choose providers based on good instincts. See somebody who really listens to know, cares about what you’re saying and don’t be afraid to change if you’re not getting that.”

Learn more about CU Medicine Urogynecology – Park Meadows and Julie LaCombe, MD.