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Pelvic organ prolapse (POP) occurs when the muscles, ligaments, and tissues of the pelvic floor weaken or become damaged, causing one or more pelvic organs to drop from their normal positions and bulge into or out of the vagina. These organs can include the bladder, uterus, rectum, small bowel, or the top of the vagina (vaginal vault). POP is a common condition, particularly affecting women over 50, and can range from mild, with no symptoms, to severe, where organs may protrude completely outside the vagina. While not life-threatening, it can significantly impact a woman's quality of life due to discomfort and functional issues.
Common symptoms
A feeling of pressure, discomfort, aching, or fullness in the pelvis or vagina.
Feeling or seeing a bulge or lump inside or coming out of the vagina.
A dragging sensation in the vagina.
Pelvic pressure that worsens with standing, coughing, or as the day progresses.
Urinary problems, such as leaking urine (incontinence), a constant urge to urinate, frequent urination, difficulty emptying the bladder fully, or a slow/spraying urine stream.
Bowel problems, including constipation, difficulty with bowel movements, feeling like the bowel is not emptying completely, or needing to press on the vaginal wall to have a bowel movement.
Pain, discomfort, or numbness during sex.
Lower backache.
Problems inserting tampons.
Vaginal discharge, irritation, bleeding, or sores inside the vagina.
Possible causes
Pregnancy and vaginal childbirth, especially multiple deliveries, large babies, or assisted deliveries (forceps/vacuum), which can stretch and strain pelvic floor muscles and tissues.
Aging and menopause, due to natural muscle strength loss and hormonal changes (lower estrogen levels) that weaken connective tissues.
Being overweight or obese, which puts increased pressure on the pelvic floor.
Chronic constipation and straining during bowel movements.
Persistent or chronic coughing, such as from smoking or respiratory conditions.
Heavy lifting or manual work.
Previous pelvic surgery, such as a hysterectomy, which can lead to vaginal vault prolapse.
Genetic predisposition or connective tissue disorders.
Medical treatment
Active monitoring (observation) for mild cases with no bothersome symptoms.
Lifestyle changes, including maintaining a healthy weight, preventing constipation (high-fiber diet, adequate fluids), and avoiding heavy lifting and smoking.
Pelvic floor muscle training (Kegel exercises) to strengthen the supporting muscles, often with a specialized physical therapist.
Vaginal pessaries: removable silicone devices inserted into the vagina to support pelvic organs and hold them in place.
Hormone treatment, such as vaginal estrogen cream, tablets, or rings, particularly for post-menopausal women to improve tissue health.
Surgery: various procedures to repair weak pelvic floor areas and reposition organs. Types include reconstructive surgery (e.g., colporrhaphy, sacrocolpopexy, sacrohysteropexy, uterosacral/sacrospinous ligament fixation) and obliterative surgery (e.g., colpocleisis).
Surgical approaches can be vaginal, abdominal (laparoscopic, robotic, or open).
Ayurvedic perspective
In Ayurveda, pelvic organ prolapse (POP) is understood as a condition resulting from the weakening of pelvic floor muscles and ligaments, often triggered by factors such as childbirth, aging, or hormonal imbalances. The Ayurvedic approach is holistic, focusing on strengthening the reproductive organs, enhancing pelvic muscle tone, and correcting underlying dosha imbalances. It is not considered a single clinical entity but is correlated with various 'Yonivyapads' (disorders related to female genitalia) depending on the degree and specific organ involved.
Ayurvedic dietary guidelines
Avoid foods that aggravate Vata dosha, such as those that are extremely sour, acrid, dry, or hard to digest.
Consume warm, nourishing, and easy-to-digest foods.
Increase hydration.
Incorporate fiber-rich foods into the diet to ensure comfortable bowel movements and prevent straining.
Include nourishing foods for the reproductive system, such as ghee, sesame seeds, almonds, and dairy products.
For aggravated Pitta dosha, consume cooling and hydrating foods like cucumbers, coconut, leafy greens, and yogurt.
Regularly practice Pelvic Floor Exercises (Kegel Exercises) to strengthen pelvic muscles.
Incorporate specific yoga postures such as Ashwani Mudra, Kumbhak Pranayama, Shoulder Stand (Sarvangasana), Bhujangasana (Cobra Pose), Mula Bandha (Root Lock), Viparita Karani (legs-up-the-wall pose), and Supta Baddha Konasana (reclining bound angle pose) to improve muscle tone and circulation.
Avoid excessive exercise or heavy lifting that can strain the pelvic floor.
Ensure adequate rest.
Manage and treat conditions like chronic constipation and diarrhea to prevent straining.
Avoid suppressing natural urges.
Maintain a balanced and nutritious diet.
Eliminate poor lifestyle choices such as irregular sleeping routines, unhealthy diets, and addictions like alcohol and smoking.
Practice stress management techniques including meditation and pranayama (breathing exercises) like Anulom Vilom.