Ashlee Williams, MD (Host): A feeling of pressure, heaviness, or even a bulge in the vaginal area can be uncomfortable, and it could be a sign of pelvic organ prolapse. The condition is common, particularly after childbirth and as women age. But effective treatments are available.

Welcome to the Healthier You podcast. I'm Dr. Ashlee Williams. And today, I'm talking with Dr. Diane Glass, a board-certified urogynecologist here at Kaiser Permanente, about what causes pelvic organ prolapse, symptoms to watch for, and what you can do about it. Dr. Glass, thanks so much for being here.

Dianne Glass, MD: Oh, thank you for having me.

Host: Yes, it's an important topic for a lot of women. So, we always like to start with the basics. What exactly is pelvic organ prolapse and what causes it?

Dianne Glass, MD: Of course. That's a great question. So, pelvic organ prolapse is a stretching or relaxation of the supports of the vagina and the uterus, frequently results in kind of a pressure feeling in the vagina and sometimes a bulge coming out of the vagina, which is actually usually the front wall of the vagina, but can be the cervix or the back wall of the vagina. it's easiest to kind of think of it as a hernia. It's not truly what it is, but it kind of gets you to the right idea of what's going on.

Host: Yeah. And it sounds quite uncomfortable.

Dianne Glass, MD: It can be very uncomfortable. It's not typically painful, but it gives people that feeling of pressure in the vaginal area or sometimes the sensation of like a tampon being stuck low in the vagina.

Host: Yeah. So, speaking of symptoms, what symptoms should women look out for and when do you think they should go see a physician about their symptoms?

Dianne Glass, MD: For sure. So if you're ever concerned that you have something going on in the vaginal area that's bothering you, I do recommend following up with your general gynecologist. But specific symptoms for pelvic organ prolapse, you know, towards the end of the day, feeling like there's something heavy in the pelvis, feeling like you have pressure, feeling like you notice something coming out of the opening of the vagina. Those are some surefire signs that prolapse or probably something that's going on. Sometimes people can have some symptoms with difficulty having bowel movements or with urinary symptoms like increased frequency or increased leakage.

Host: Are there things that women can do to reduce their risk of getting prolapse, or is there anything they can do to prevent it from getting worse?

Dianne Glass, MD: For sure. So, pelvic floor muscle exercises are something that can be very helpful. Pelvic floor muscle exercises are Kegels. And I describe those to people as the muscles that help you hold your urine. So if you're trying to stop the flow of urine, those would be the muscles that we're doing Kegel exercises with.

Avoiding constipation can be really helpful. When you're straining with constipation, it puts a lot of pressure on the pelvic organs and can worsen or cause prolapse. And really heavy lifting can also exacerbate prolapse.

Host: So once you have the diagnosis of prolapse, what treatment options are available to women?

Dianne Glass, MD: You have a bunch of different options. And so, I think first and foremost, the most important thing to know about pelvic organ prolapse is that it really, for the most part, is not dangerous. So, just because you have it doesn't mean we have to do anything about it. Observation is a very real option.

Pelvic floor muscle exercises can be helpful. They can reduce the amount of time that you're bothered by the prolapse. They don't typically make it go away, but they do help you experience the symptoms less often. There are treatments like a pessary, which is a silicone disc that would go inside the vagina to help support the vagina. That's Something that people can wear kind of like comfortable shoes. Some people wear, them all day, every day. Other people just wear them situationally when they know that prolapse is going to bother them. And then, there's surgical options also for repairing prolapse.

Host: And you know, the pelvic floor is a very complicated muscle. So just a shout-out, we do have a previous recording with one of our amazing board-certified OB-GYNs about the pelvic floor, for one of the Healthier You podcast episodes.

So, coming from a urogynecologist, what is the most important message that you would like women to know about the pelvic floor and pelvic organ prolapse?

Dianne Glass, MD: Yeah, for sure. So I think the most important thing to know about pelvic organ prolapse is that it is actually incredibly common. About 25% of people have pelvic organ prolapse. It is not weird. It is not something you shouldn't talk to your doctor about. You shouldn't be embarrassed about it. It is something that is really, common and that we see all the time. So, feel free to discuss it with us.

And as far as the pelvic floor goes, you know, there are a lot of muscles in the pelvic floor, and they are muscles that we don't necessarily know how to control. We never really had reasons to think about them. They usually just do their job. When they start having some dysfunction, being too tight or not tight enough, it can cause problems. And so, something that can be helpful to talk with your doctor about as well if you're having discomfort in the vaginal area or pelvic discomfort, or if you're noticing some sort of bulging symptoms.

Host: Thanks for this great information, Dr. Glass. We learned a lot about pelvic organ prolapse, what causes it, and the treatment options available. Here are the top takeaways.

One, pelvic organ prolapse is common. It happens when the muscles and connective tissue supporting the pelvic organs weaken, allowing organs such as the bladder, uterus, or rectum to shift or bulge into the vaginal canal. Pay attention to symptoms such as pressure, heaviness, or a vaginal bulge. Urinary or bowel symptoms and discomfort during daily activities can also be signs of prolapse.

Getting enough fiber, staying hydrated, and avoiding straining during bowel movements can help symptoms from getting worse.

There are several treatment options depending on your symptoms and goals. Treatment may include lifestyle changes, pelvic floor physical therapy, a pessary, or even surgery.

You don't have to live with prolapse symptoms. If you're experiencing discomfort, difficulty emptying your bladder or bowels, pelvic pain, or even other symptoms, talk with your doctor about your treatment options.

For more expert insights, visit kp.org/doctor and explore more episodes of Healthier You wherever you get your podcasts. If you found this episode helpful, be sure to subscribe so you don't miss what's next. And leave a comment with topics you'd like for us to cover in future episodes. Thank you. And from all of us at Kaiser Permanente, be well.