I thought my bladder issue was just a post-pregnancy symptom. Turns out I had POP—aka a drop of the pelvic organs. It sounds scary, but it's manageable. Here's what you need to know.

By Angela Hatem
November 02, 2020
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When I had my son 17 months ago, seasoned moms everywhere warned me about the standard things. The never sleeping again thing, the sore nipple thing, the "you're going to poop on the table" thing.

My son was a behemoth of a baby, so he was delivered via C-section. No pooping on the table for me. My milk never came in, so my nipples were salvaged. I lost the battle when it came to sleep, but I figured two out of three isn't so bad.

Fast-forward to the present when the floor literally went right out from underneath me—my pelvic floor that is. That was something no one ever warned me about it. It's hard to identify your situation when you don't even know the situation you have exists.

Credit: Yeji Kim

My initial symptom was a feeling that I wasn't quite emptying my bladder. I dismissed it at first as post-pregnancy bladder. Then it got to be persistent—irritatingly and insanely persistent. It didn't hurt to go, but I just wasn't really going. A pelvic ultrasound, CAT scan, misdiagnosis of urinary tract infection (UTI) and then overactive bladder, two unnecessary prescriptions, two urologists, and so many trips to the bathroom later, a urologist said to me, "I think you have a prolapse."

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) occurs when there is a drop of the pelvic organs caused by the loss of normal support of the vagina. The pelvic organs include the vagina, cervix, uterus, bladder, urethra, intestines, and rectum. All of these organs are supported and held in place by the muscles in the pelvic floor. When those muscles become weakened, stretched, and fail to tighten back up—like they sometimes do during and after pregnancy—that's when a problem may arise.

For me, it felt like my prolapse came on rather suddenly, but according to Daun Hooley-Miller, a women's health nurse practitioner at Ascension St. Vincent in Carmel, Indiana, there really isn't anything sudden about it. "Many women may suddenly feel symptoms, but it usually takes months or years to work its way to where you notice," says Hooley-Miller. "Women do not become symptomatic till the organs come near the vaginal opening."

Symptoms will look and feel different from person to person, stage to stage, and may vary based on the type of prolapse they are experiencing, adds Hooley-Miller.

Types of Pelvic Organ Prolapse

Prolapse can also happen in men—of the rectum or bladder—but it is much more common in women. About 50 percent of women have prolapse to some degree, but do not let that frighten you. While prolapses can be uncomfortable, upsetting, and frustrating, they shouldn't hurt and are not life-threatening.

According to the American College of Obstetricians and Gynecologists, there are several types of pelvic organ prolapse:

  • Cystocele: the bladder drops into the vagina
  • Enterocele: the small intestine bulges into the vagina
  • Rectocele: the rectum bulges into the vagina
  • Uterine prolapse: the uterus drops into the vagina
  • Vaginal vault prolapse: the most severe, in which the top of the vagina loses its support and drops

Causes of Pelvic Organ Prolapse

There are a variety of factors to why a prolapse can occur, but "childbirth is the leading contributor to pelvic organ prolapse," according to Hooley-Miller. That said, prolapse can happen for other reasons, too.

"People who have never been pregnant can have pelvic floor prolapse," says Hooley-Miller. Reasons include constipation, straining to urinate or defecate, coughing, genetics, and repetitive heavy lifting. "Squatting when lifting may be good for your back, but not your pelvic floor," adds Hooley-Miller.

Symptoms of Pelvic Organ Prolapse

There are a variety of symptoms that may come along with POP, says Bri Grogan, P.T., DPT, a physical therapist and founder of FemFusion Fitness, a digital platform for at-home fitness and pelvic health.

"Some women complain of feeling a golf ball in their vagina," says Dr. Grogan. "There is also sometimes pressure or heaviness in the pelvis. Anytime you bear down for any reason you will notice it. Or you will notice it after you have been lifting things, such as your baby, all day. You may also feel pressure on the bladder; a feeling that you always have to go."

Some may not even notice their prolapse, while others will experience a range in symptoms and severity depending on the stage. Stages one and two are considered mild to moderate, while stages three and four lean toward a more severe prolapse.

Treatment for Pelvic Organ Prolapse

There are things to do that may prevent prolapse, including avoiding constipation/straining, not pushing to urinate, and lifting correctly (think weights, kids, bags, and boxes). But sometimes even the most fit people experience it—yes, it can just happen!

Severe cases of prolapse may require surgery. In other cases, some opt for pessaries, a device inserted non-surgically into the body to support the vaginal tissues. For other instances, there are ways to ease the symptoms. "We can do management," says Hooley-Miller. "We try to avoid things that will make the prolapse worse."

Make small lifestyle changes

Lifestyle changes can go a long way in addressing the symptoms of prolapse, says Dr. Grogan. How you transition from sit to stand, bettering your diet and exercise, giving up smoking, and taking your time to use the bathroom are just some lifestyle adjustments that may have a positive impact on prolapse symptoms.

Do Kegel exercises

Health care providers commonly recommend Kegel exercises to strengthen those weakened pelvic floor muscles. Dr. Grogan also notes the benefits of Kegels, but endorses them with a hint of caution. "They have to be done right, gradually, progressively, and done by people who know how to release their pelvic floor muscles," she says.

Before you begin the process of bulking up those muscles, Dr. Grogan encourages patients to first give them a much-deserved breather. "You can't go wrong with pelvic floor relaxation," says Dr. Grogan. "Learn how to relax the muscles of the pelvic floor so that you can know when you are truly contracting them."

See a pelvic floor physical therapist

As for me, I am taking Dr. Grogan's advice and am working on relaxing what I have found to be a very tense pelvis, as well as setting an appointment with a pelvic floor physical therapist who will help assess and treat my prolapse. Before this whole saga began, I didn't even know such a therapy existed, but it is out there, and it is covered by my insurance.

Engage in exercise

For those of you who do not have coverage or do not have a pelvic floor physical therapist in your area, there are some helpful pelvic floor workout videos available on YouTube, such as those on Dr. Grogan's FemFusion Fitness and Pelvic Health channel.

It's daunting, and it doesn't sound like I will be Kegeling my way out of this situation overnight, but I am encouraged and a little less terrified after speaking with the experts. At the very least, now I know I have options and things that I can try to help manage the situation. That alone makes me feel a smidge better.

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