Early medical care for pelvic organ prolapse symptoms can improve women's quality of life, experts say

The Hindu

20-05-2025

Pelvic organ prolapse (POP) is far more common in India than most realise. Some research studies have found that up to 21% of women may experience clinically relevant POP. While nulliparous prolapse (in women who haven't given birth) accounts for just 1.5–2% of genital prolapse cases, the incidence jumps to 5–8% in women who have had one or two children -- among the highest globally. Although literature reports that 50% of women are affected by POP in their lifetime, doctors say the real number may be closer to 70–80%, with most cases going unreported due to stigma or lack of awareness.
According to the World Health Organization (WHO), POP occurs when one or more pelvic organs -- such as the bladder, rectum, or uterus -- descend from their normal positions into or through the vaginal canal, due to the weakening of the pelvic floor muscles and connective tissue. It is a condition that impacts the lives of thousands of Indian women, particularly in their postmenopausal years.
Lack of awareness leading to late detection
Though POP has been recorded as early as 2000 BC in ancient texts, it remains misunderstood and underdiagnosed, especially in India. Many women accept the symptoms as a natural part of aging or womanhood. Shame, silence, and cultural stigma often prevent them from seeking timely help. Only a small percentage of women undergo treatment, despite its major impact on quality of life.
Medical experts say early detection and intervention can drastically reduce the physical, emotional, and social toll POP takes on women. While a large percentage of women experience some degree of prolapse, only a subset develop symptoms significant enough to seek treatment. Even then, many remain undiagnosed.
Sapna Raina, senior consultant at Narayana Health City, Bengaluru, explains, 'Pelvic organ prolapse primarily happens because of the weakening of pelvic floor and gluteal muscles. Multiple vaginal deliveries, prolonged labor, use of forceps during childbirth, poor antenatal or postnatal care, chronic constipation or cough, menopause, lifting heavy weights, smoking, and obesity—all contribute to this weakening.'
She emphasises that menopause plays a critical role due to the natural drop in estrogen, which compromises the strength and elasticity of pelvic tissues. She also notes that poor lifestyle practices and delayed care further worsen the condition.
Importance of seeking care early
POP often begins subtly. Early signs include urinary leakage when coughing or sneezing. As it progresses, women may experience a dragging sensation in the lower abdomen, difficulty urinating or passing stool, or a visible bulge at the vaginal opening. In advanced cases, symptoms can include repeated infections, foul-smelling discharge, chronic back pain, and significant discomfort while walking or sitting.
Mannan Gupta, chairman and HOD of obstetrics and gynaecology at Elantis Healthcare, New Delhi, says, 'It's very common in older women who've had multiple normal vaginal deliveries. The uterus, rectum, and bladder can descend, and in severe cases, even protrude through the vaginal canal. Treatment at that stage often requires surgery.' He adds that awareness remains low, particularly among elderly women, many of whom endured childbirth in the 1980s and 1990s under limited medical supervision. These women now present in their later years with advanced POP.
Jaishree Gajaraj, head of obstetrics and gynaecology at MGM Healthcare, Chennai,says, 'Many women live with this for years, thinking it's just a part of growing old. But those who undergo treatment --whether non-invasive or surgical --often feel like they've regained their life.'
Non-surgical and surgical management
Early diagnosis can prevent progression. Mild prolapse can be managed with pelvic floor physiotherapy, including Kegel exercises and strengthening of the core and gluteal muscles. Preventive care also includes addressing chronic constipation, avoiding heavy lifting, managing weight, and ensuring good antenatal/postnatal care.
'Regular exercise and timely medical attention are key,' says Dr. Raina. 'In the early stages, prolapse can often be corrected without surgery. 'However, when the condition advances, surgical intervention may be necessary. Dr. Gupta adds, 'Delaying care means patients may require surgery under general anesthesia, which is riskier for elderly women or those with co-morbidities.' Surgical options such as laparoscopic repairs or mesh implants are available for more severe cases. Dr. Gajaraj elaborates on the surgical process, 'When the uterus descends, it pulls the bladder in front and the rectum behind. Surgery typically involves removing the uterus, repositioning the bladder and rectum, and tightening the vaginal wall to restore pelvic support.'
Post-surgery, most women report relief from symptoms such as urinary incontinence and pelvic discomfort. Many regain their mobility, independence, and confidence within a few weeks.
Call for awareness, better programmes and timely action
Despite POP's widespread impact, it remains absent from national health conversations. Dr. Gupta remarks, 'There are campaigns for conditions like anaemia and diabetes, but nothing specifically for pelvic organ prolapse.' He calls for awareness programmes, particularly in rural and semi-urban regions where symptoms are often normalised or ignored.
Dr. Raina confirms that there are currently no dedicated government programmes for prolapse, though it may be loosely addressed under general maternal and reproductive health schemes. 'Honestly, we don't have standalone programs for this. Some degree of prolapse is seen in 70–80% of women, but symptomatic full-blown cases are still under 5%,' she says.
Most women don't even know their suffering is due to a treatable condition,' says Dr. Gajaraj, emphasising the need to normalise conversations around pelvic health, while acknowledging initiatives like the Society of Vaginal Surgeons of India, where she was formerly the director, and stressing that both awareness and access to care must improve.
Experts stress that POP should not be accepted as an inevitable consequence of childbirth or ageing. With better education, early detection, lifestyle changes, and appropriate medical interventions, women can reclaim not only their health, but also enjoy a better quality of life.