Pelvic organ prolapse (POP) occurs when one of the pelvic organs (bladder, bowel or uterus in women) drops from its original position and causes tissue to bulge into, or protrude out of, the vagina or rectum. These organs are usually held into place by the supporting muscles, tissues and ligaments, called the pelvic floor. When the pelvic floor is weak, has been stretched or damaged (from childbirth for example), it is no longer able to effectively support these organs, which can lead to the condition [1].

The condition can affect men, but is much more common in women, with as many as 40% of women estimated to experience some form of pelvic organ prolapse in their life [1].

POP can come with uncomfortable symptoms - one of the most common being urinary incontinence. In fact, a 2006 study found that up to 60% of women with POP are also diagnosed with urinary incontinence [2]. It’s not uncommon for sufferers to experience faecal incontinence too, with somewhere between 20-40% of those with POP having some degree of faecal incontinence or leakage [3].

In this article, we explain how a pelvic organ prolapse can lead to incontinence, as well as ways to manage the condition.

There are many different reasons your pelvic floor can weaken to increase the likelihood of POP, including:

• Vaginal childbirth: Giving birth vaginally, especially having multiple vaginal deliveries, is the most common
  factor linked to developing a pelvic organ prolapse. It’s estimated that around half of all women who have had a child experience some level of prolapse, although not all will experience symptoms [4,5].
• Menopause and ageing: As a woman ages and goes through menopause, oestrogen levels in the body decline which can lead to a weakening of the connective tissues in the pelvic floor [5].
• Genetic predisposition: If there is a history of pelvic organ prolapse in your family, you may have increased odds of developing it yourself at some point in life [5].
• Excess weight: Being overweight can impact your likelihood to develop pelvic organ prolapse, as carrying excess weight can increase pressure in the abdomen [5,6]. This in turn weakens the pelvic floor and not only increases the risk of developing POP, but also increases the risk of recurrance after treatment [6,7].

Some of the most common symptoms of POP include [4,8]:

• The feeling of pressure or fullness in the vagina or pelvic region

• A bulge or lump of protruding tissue coming out of the vagina or rectum that you can feel or see

• Difficulty passing urine or having a bowel movement

• Urinary and/or faecal incontinence

It is important to seek medical advice sooner rather than later if you’re experiencing any of these symptoms or a combination of them. Diagnosing POP early avoids it worsening, and can mean it's more easily treated [9].

The descent of the organ causing the prolapse can put pressure on other pelvic organs, including the bladder, which can cause urinary problems.

For someone experiencing a pelvic organ prolapse, they might experience urinary leakage, the need to urinate more frequently or get strong, sudden urges to urinate.

POP can cause different types of urinary incontinence, such as [7]:

• Stress incontinence
• Urge incontinence
• Overflow incontinence

The rectal sphincter is part of the muscles within the pelvic floor, so as these muscles weaken or are damaged, there may be a loss of control over the sphincter - and therefore defecation [3].

Just like with its effect on urinary incontinence, a pelvic organ prolapse can put pressure on other pelvic organs including the bowel. It’s possible to experience faecal leakage or a diminished ability to control or hold on to bowel movements [3].

If you suspect you’re experiencing pelvic organ prolapse, an appointment with your GP is your first step for treatment.

Your doctor will discuss your symptoms, medical history and most likely perform a pelvic exam to determine the level of the prolapse and which organs are involved [11]. Your doctor can then make any necessary referrals to other specialists or for any tests and images that may be required.

Unfortunately, many women suffer with the condition in silence and don’t seek medical treatment, sometimes for years. A 2016 study found that 54% of women with the condition (that were surveyed) did not seek medical advice [13].

Multiple factors have been found to influence the decision to seek medical treatment for POP, including feeling shame about having the condition, or not being aware of the condition at all [14].

Remember that there is nothing to be ashamed about, and seeking medical treatment early is important to ensure it doesn’t worsen. Pelvic organ prolapse is extremely common and can be treated, so you don’t need to live with the discomfort the symptoms can bring.

After a diagnosis of pelvic organ prolapse from the GP, they will tailor a treatment plan to the individual needs of the patient, taking into account the type of prolapse, the severity and the degree of impact on daily life [1].

While surgery is an option for treatment in more severe cases, there are a two common nonsurgical options you might be recommended if the degree of prolapse is mild to moderate [15]:

• Pelvic floor exercises and/or physical therapy

• The use of a pessary (a removable device that is placed into in the vagina to hold prolapsed organs in place)

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While the symptoms of pelvic organ prolapse can be uncomfortable, it is a very common condition and there are multiple options for treatment and management to help you get back to living your day-to-day life with confidence!