Stages of a Pelvic Organ Prolapse

The word prolapse means “to fall out of place” and is used to describe the action of an organ drooping or sagging and slipping out of its natural place. A pelvic organ prolapse can affect any organ within the pelvic area. In women this includes the uterus, vagina, small bowel, rectum, bladder and urethra.

There are four main stages of a pelvic organ prolapse, as graded using the Pelvic Organ Prolapse Quantification System (POP-Q). These start from a minor movement of the organ, to a complete prolapse where the organ is permanently protruding from the body. Your prolapse can get worse throughout the day or after you have been on your feet after a long time. This will be taken into consideration by your doctor as they grade your prolapse.

Any pelvic organ can prolapse, usually into the vagina (if the vagina prolapses in on itself, it's usually as a result of another organ prolapsing first and taking the vagina with it). This is why a pelvic organ prolapse is often also referred to as a vaginal prolapse. You can read more about each type of possible pelvic organ prolapse on our Types of Prolapse page.


Pelvic Organ Prolapse Quantification System (POP-Q)

There are four different stages or grades that doctors use to describe prolapse severity, using the Pelvic Organ Prolapse Quantification System (POP-Q). Stage one, or first degree prolapse being the most mild, and a stage four, or fourth degree prolapse being the most severe. Doctors use quantitative measurements from a physical examination to categorise your prolapse, however, below we have described how this may be experienced in a patient:

  • Stage 1, mild or slight – If your prolapse is at this stage, you may present no symptoms. You may not even know that you have a prolapse until it is picked up as part of a routine medical examination such as a smear test. The pelvic organs are still well supported.
  • Stage 2, moderate – If your prolapse has reached this stage, you may experience symptoms such as a heaviness or full feeling in the general pelvic area, or a dragging sensation. You may also experience pain or discomfort during sex. The prolapsing organ is still inside the body but has fallen away from its normal position.
  • Stage 3, severe – At stage three you are more likely to experience a number of symptoms, more frequently and with more severity. Sometimes, you may feel a lump or a bulge inside the vagina. Occasionally, for example if you cough, sneeze or laugh, the organ can protrude slightly and temporarily to the outside of the vagina.
  • Stage 4, complete – This stage is sometimes referred to as a complete prolapse. You’ll experience severe symptoms, possibly most or all of the above. You’ll feel extremely uncomfortable and will notice a fleshy protrusion from the outside of your vagina.

How Do I Look After My Pelvic Floor?

A prolapse is shocking and upsetting for any woman. It is estimated that half of all women who have had children will experience some degree of pelvic organ prolapse in their life. If you experience one form of vaginal prolapse, you then become more likely to experience further prolapse of other pelvic organs. Also, around 30% of women who have pelvic organ prolapse surgery will require repeat surgery.

This is why it’s so important to look after your pelvic floor muscles, whatever stage of life you’re at. It doesn’t matter if you’re young and having children hasn’t even crossed your mind, looking after your pelvic floor is crucial. The best way to look after your pelvic floor muscles is to make sure you perform pelvic floor/Kegel exercises daily. These exercises are simple to carry out and can be done on the way to work, at your desk or when relaxing on the sofa. And the beauty is, no one will know you’re doing them! Done regularly, they will help to strengthen the pelvic floor muscles and will help to keep them doing their job.

You can make them even more targeted by using an electric pelvic toner too. This simple machine has a fantastic prolapse programme to help with any vaginal prolapse symptoms and prevent them from becoming worse.

To learn more about Prolapse Prevention, follow the link.


Sources

Cauni, V. Chapple, C. R. Geavlete, P. Gutue, S. Persu, C. (2011). Journal or Medicine and Life. Pelvic Organ Prolapse Quantification System (POP–Q) – a new era in pelvic prolapse staging. [online] 4(1). p 75-81. [viewed 28/03/2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056425/

Ellis, J. Hargreaves, E. (2013). Exercise and Advice for Vaginal Prolapse. Patient Information Leaflet [online] The Newcastle upon Tyne Hospitals, NHS Foundation Trust, 2013 [viewed 22/03/2018]. Avaialble from: http://www.newcastle-hospitals.org.uk/downloads/Therapy%20Services/Physio_Vaginal_prolapse2.pdf

NHS. (2016) Safe lifting tips [online] National Health Service, 2016 [viewed 20/03/2018]. Available from: https://www.nhs.uk/livewell/workplacehealth/pages/safe-lifting-tips.aspx

NICE. (2015). Urinary incontinence in women: management, 1 Recommendations [online] National Institute for Health and Care Excellence, 2015 [viewed 14/03/2018]. Available from: https://www.nice.org.uk/guidance/cg171/chapter/1-Recommendations#physical-therapies