Pelvic Organ Prolapse: Types, Stages, & Treatment NYC

What is a Pelvic Organ Prolapse (POP)?

The pelvic floor muscles are muscles located between the tailbone (coccyx) and the pubic bone within the pelvis. They play a vital role in supporting your internal organs such as bladder, uterus, rectum.

They aid in stabilizing the hip, low back, pelvis. They contract to keep urine and feces in and when the time is right they relax to help you urinate and defecate without pain.

These muscles help you have pain free penetration, sex and acheive orgasm. They work together with your diaphragm to optimize breathing pattern. 

Pelvic organ prolapse occurs when pelvic organs such as the bladder, urethra, rectal, or uterine tissue bulge into or out of the vagina. This condition is caused by weak pelvic floor muscles that can no longer support the burden of the surrounding connective tissue, allowing organs to fall and disrupt weak points on the vaginal wall.

Types of POP

• Cystocele. The bladder drops into the vagina- anterior wall loss of support 

• Urethrocele. The uterus drops into the vagina- anterior wall loss of support

• Enterocele. The small intestine bulges into the vagina- posterior wall loss of support

• Rectocele. The rectum bulges into the vagina- posterior wall loss of support 

• Vaginal Vault Prolapse. The top of the vagina loses its support and drops.

Stages of POP

The International Continence Society/International Urogynecology Association Pelvic Organ Prolapse Quantification (POP-Q) system:

• (Stage 0) No prolapse is demonstrated

• (Stage I) Most distal portion of the prolapse is more than 1 cm above the level of the hymen.

• (Stage II) Most distal portion of the prolapse is 1 cm or less proximal to or distal to the plane of the hymen. 

• (Stage III) The most distal portion of the prolapse is more than 1 cm below the plane of the hymen. 

• (Stage IV) Complete eversion of the total length of the lower genital tract is demonstrated

Pelvic Floor Physical Therapy for POP

Pelvic floor physical therapy aims at reducing POP symptoms. We look at the whole body and how it is moving.

A Pelvic PT will examine your movement patterns, breathing, spinal health, hip, core as well as do an pelvic floor internal muscle exam (if patient is comfortable with this).

Doing an internal assessment of the pelvic floor muscles will give the therapist vital information about it’s endurance, strength, ability to  contract, relax, bear down, presence of any prolapse. 

The pelvic exam involves the physical therapist assessing the pelvic floor by gently inserting one gloved and lubricated finger into either the vagina or rectum to assess muscle tone, motor control, strength, tenderness. 

Given examination results, the therapist can determine the best course of treatment specific to each individual.