It’s a fact of life—as we age, our muscles begin to loosen. And it’s not just faces and figures that relax. Internal organs can lose their firmness, too, resulting in pelvic organ prolapse, when these organs fall.
UNC Health OB-GYN Tiffany M. Flanagan, MD, doesn’t mince words: “Gravity does not like women at all. Everything falls down, top to bottom.”
Men can have pelvic organ prolapse, too, but it’s less common. Carrying children and having reproductive organs located internally put women at higher risk.
“We have our bladder, uterus, rectum, intestines, vagina, all competing for space in the pelvis,” Dr. Flanagan says. “As they lose their support, they can begin to move downward, and sometimes out. In our culture, this is embarrassing to talk about, but it is very common.”
Pelvic Prolapse? You’re Not Alone
By age 60, 1 out of 3 American women have pelvic floor issues, Dr. Flanagan says. By age 80, half of women have pelvic floor prolapse.
The consequences vary, depending on which organs are descending. Symptoms can include incontinence (urinary and/or fecal), uncontrollable gas, constipation, pain during sex and bulges that can be felt in the vagina or seen hanging out (herniations).
“A lot of women try to hide their symptoms,” she says. “In doing so, they hide themselves. The pandemic has taught us that self-isolating can lead to other struggles, including mental health and social challenges.”
For many women, childbirth increases the risk of pelvic organ prolapse by stretching and weakening the vaginal walls. Even if you had a caesarean section, carrying the baby places downward pressure on the pelvic floor, which supports the uterus and other organs.
Prolapse Risk Factors Unrelated to Pregnancy
Some causes of pelvic floor prolapse are not related to pregnancy.
“Anyone who has a job that involves heavy lifting puts strain on their pelvic organs,” Dr. Flanagan says. “Also, people who have chronic constipation and push to have a bowel movement are at risk.”
Other risk factors are strenuous exercise or recreation, family history and smoking. Smoking can thin collagen, a structural protein in connective tissue, and can cause “smoker’s cough,” which strains the pelvic floor.
Carrying too much weight also puts stress on the pelvic muscles.
“If you’re challenged by weight gain, then losing a few pounds may help your pelvic floor,” she says.
Reduce Your Risk of Pelvic Floor Prolapse
Dr. Flanagan recommends that women do Kegel exercises to strengthen their pelvic floor. Kegels involve tightening and releasing the muscles in the pelvis, but make sure you talk to a doctor or physical therapist about how to do them the right way.
“These can be done incorrectly, and may do more harm than good,” Dr. Flanagan says.
You may find instructional websites and videos online, she says, but make sure you are using a reliable resource. (Here are instructions from the American College of Obstetricians and Gynecologists.)
Another option is physical therapy, which can be very helpful in the weeks after giving birth (“the fourth trimester”) or even years later, for women who are tired of symptoms such as peeing when they sneeze, for example.
“There are physical therapists who specialize in pelvic floor health,” she says. “They will do an internal and external exam to see what’s going on, then work with individuals to strengthen those muscles.”
If you deal with chronic constipation, add fiber to your diet, try not to strain when you’re having a bowel movement and talk to your doctor about easing your symptoms. This may help protect your pelvic muscles.
Treatment for Pelvic Organ Prolapse
When exercises and dietary changes aren’t enough to stop or reverse pelvic organ prolapse problems, then, Dr. Flanagan says, “it’s time to start talking about putting things back where they belong.”
Devices called pessaries can be used in the vagina to help relieve bulges and support kinked passages. They can be designed to hold up the rectum, bladder, uterus or any combination. Most women can insert them and take them out themselves. However, they should first be fitted by a doctor.
“It’s not one-size-fits-all,” Dr. Flanagan says. “Different pessaries help different kinds of prolapse.”
The goal with pessaries, exercises and other treatments is to stabilize the pelvic area. But when pelvic organ prolapse has progressed to the point that organs are bulging into other organs and hindering proper functioning, or if they are herniated, then surgery may be needed.
“Prolapse surgery today is minimally invasive,” she says. “In the 1990s, it was major surgery. But now the procedure has advanced to being outpatient or an overnight stay.”
Some prolapsing organs may be removed or sutured back in place. Surgical mesh may be used to repair the hernia. Surgeons can often enter through the vagina, eliminating the need for abdominal incisions, or they can perform the surgery laparoscopically, with small incisions. Sometimes a hysterectomy is performed at the same time.
The bottom line is that pelvic organ prolapse is common, Dr. Flanagan says, and she hopes women will speak up and ask their doctor about treatment.
“A lot of women think it’s just something they have to live with,” she says. “If it doesn’t bother you, then that’s fine. But if it does, you may be able to do something about it.”
If you are experiencing symptoms of pelvic floor prolapse, talk to your doctor, or find one near you