POP Risk Factor Questionnaire: Are You at Risk?

Pelvic organ prolapse doesn't happen randomly. Certain factors significantly increase your likelihood of developing this condition, and understanding your personal risk can help you take preventive steps or recognize symptoms early when treatment is most effective.

Some risk factors you can't change, like your genetics or past pregnancies. Others you have control over, like maintaining a healthy weight or treating chronic cough. Taking a clear-eyed look at your risk profile empowers you to protect your pelvic floor health or seek help if symptoms develop.

Take the POP Risk Factor Questionnaire — available in 17 languages: https://www.pelvicorganprolapsesupport.org/could-you-have-pop

Family History and Genetics

Your genes play a bigger role in prolapse risk than most people realize. Prolapse runs in families because the strength and quality of your connective tissue is partly inherited. Women whose mothers or sisters have prolapse are at significantly higher risk themselves.

Certain genetic conditions affect connective tissue quality throughout your body. Ehlers-Danlos syndrome, Marfan syndrome, and other connective tissue disorders make prolapse more likely and often cause it to develop earlier and more severely. Even without a diagnosed connective tissue disorder, some women are simply born with naturally weaker or more elastic tissues that provide less pelvic floor support.

Knowing your family history helps you understand your baseline risk. Women with strong family histories of prolapse benefit from being proactive about pelvic floor health, even before symptoms appear. Regular pelvic floor exercises, avoiding activities that strain the pelvic floor, and early intervention at the first sign of symptoms can make a significant difference.

Pregnancy and Childbirth

Pregnancy and vaginal delivery are among the strongest risk factors for prolapse. The weight of your growing baby, hormonal changes that loosen your ligaments, and the physical trauma of pushing a baby through your birth canal all take a toll on your pelvic floor.

Your risk increases with each pregnancy and delivery. Women who've had multiple children, especially closely spaced pregnancies, have significantly higher prolapse rates. Large babies over nine pounds, prolonged pushing during labor, and instrumental deliveries using forceps or vacuum extraction all increase risk further.

Cesarean delivery doesn't eliminate prolapse risk since much of the damage happens during pregnancy itself, but it does reduce the additional trauma of vaginal delivery. Women who've had only cesarean deliveries have lower prolapse rates than those who've delivered vaginally, though they're still at higher risk than women who've never been pregnant.

Tearing during delivery, particularly third and fourth degree tears that extend into the anal sphincter, damages pelvic floor structures and increases future prolapse risk. Even women who heal well from these tears have sustained injury that may contribute to prolapse years later.

Age and Menopause

Getting older increases prolapse risk as tissues naturally lose strength and elasticity over time. The dramatic drop in estrogen during menopause accelerates this process, weakening the muscles, ligaments, and connective tissues that support your pelvic organs.

Postmenopausal women have significantly higher prolapse rates than premenopausal women. The longer you've been postmenopausal, the higher your risk, with prolapse rates continuing to increase into your seventies and eighties. This doesn't mean prolapse is inevitable with age, but it does mean protecting your pelvic floor becomes increasingly important as you get older.

Using vaginal estrogen after menopause may help maintain tissue strength and reduce prolapse risk, though more research is needed to confirm this protective effect. Staying active, maintaining muscle strength, and continuing pelvic floor exercises throughout your life all help counteract age-related weakening.

Weight and Body Mass Index

Carrying excess weight puts constant pressure on your pelvic floor. The heavier you are, the more downward force your pelvic floor must resist every moment of every day. This chronic stress weakens support structures over time and makes prolapse more likely.

Obesity significantly increases prolapse risk, with studies showing obese women have forty to seventy-five percent higher risk compared to normal-weight women. Even being moderately overweight increases risk, though not as dramatically as obesity.

Weight gain after an initial prolapse diagnosis often makes symptoms worse. Many women notice their bulge becomes more prominent as they gain weight and improves when they lose weight. Maintaining a healthy weight is one of the most effective things you can do to protect your pelvic floor or prevent prolapse from worsening.

Chronic Straining and Pressure

Activities and conditions that repeatedly increase abdominal pressure strain your pelvic floor over time. Chronic constipation and straining during bowel movements create significant downward pressure. Years of straining can stretch and weaken pelvic floor support structures.

Chronic cough from smoking, asthma, or chronic bronchitis repeatedly stresses your pelvic floor with every coughing fit. The explosive force of a cough creates tremendous downward pressure. Heavy lifting, whether as part of your job or regular exercise routine, can contribute to prolapse, especially if you lift with poor technique or hold your breath during lifts.

Addressing these factors reduces ongoing stress on your pelvic floor. Treating constipation, managing chronic cough, quitting smoking, and using proper lifting technique all help protect against prolapse or prevent existing prolapse from worsening.

Occupational and Lifestyle Factors

Some occupations put women at higher risk for prolapse. Jobs requiring prolonged standing, heavy lifting, or repetitive straining stress the pelvic floor daily. Nurses, retail workers, warehouse employees, and others whose work demands long hours on their feet or frequent heavy lifting face elevated risk.

High-impact athletics and intense exercise can contribute to prolapse in some women, particularly those with underlying risk factors. Running, jumping, heavy weightlifting, and exercises that repeatedly increase abdominal pressure may accelerate pelvic floor weakening in susceptible women.

This doesn't mean you should avoid physically demanding work or stop exercising, but it does mean being mindful about protecting your pelvic floor. Using proper body mechanics, taking breaks to rest, doing regular pelvic floor exercises, and paying attention to early symptoms all help mitigate occupational and athletic risks.

Previous Pelvic Surgery

Hysterectomy increases prolapse risk, particularly when the uterus is removed vaginally rather than abdominally. The surgery disrupts normal pelvic support structures, and scar tissue that forms during healing may not provide the same strength as original tissues. Risk increases further if you had prolapse or pelvic floor weakness before your hysterectomy.

Other pelvic surgeries including bladder repairs, previous prolapse repairs, and surgeries for endometriosis or other pelvic conditions can all affect pelvic floor support. Each surgery creates scar tissue and potentially weakens structures that help hold your organs in place.

Having previous prolapse surgery that failed is a strong predictor of future prolapse problems. If you've had one prolapse repair that didn't hold up, your tissues have demonstrated they don't heal as strongly as they should, putting you at high risk for recurrence.

Medical Conditions That Increase Risk

Several medical conditions affect your prolapse risk beyond what you can control through lifestyle. Connective tissue disorders like Ehlers-Danlos syndrome or Marfan syndrome significantly increase risk. Chronic lung disease that causes frequent coughing puts ongoing stress on your pelvic floor. Diabetes may affect nerve and tissue health in ways that compromise pelvic floor function.

Conditions causing chronic increases in abdominal pressure including chronic constipation, abdominal tumors, or chronic coughing from any cause all strain your pelvic floor repeatedly. Nerve damage from diabetes, multiple sclerosis, or spinal injuries can affect pelvic floor muscle function and increase prolapse risk.

Managing these conditions as well as possible helps reduce their impact on your pelvic floor. Working with your doctors to optimize treatment for chronic conditions protects not just your overall health but your pelvic health specifically.

Assessing Your Personal Risk

Looking honestly at your risk factors helps you understand your vulnerability to prolapse. Having multiple risk factors doesn't guarantee you'll develop prolapse, and having few risk factors doesn't make you immune. However, knowing where you stand helps you make informed decisions about prevention and early intervention.

High-risk women benefit from being proactive. Regular pelvic floor exercises starting in your twenties or thirties, attention to maintaining healthy weight, aggressive treatment of constipation and chronic cough, and careful attention to early symptoms all help prevent prolapse or catch it at mild stages when conservative treatment works best.

Even women with significant risk factors can often prevent or delay prolapse through lifestyle modifications and pelvic floor maintenance. Your genes and history don't determine your destiny, they just inform how vigilant you need to be about protecting your pelvic floor.

Taking Action Based on Your Risk

Understanding your risk profile guides your prevention and management strategy. Women with multiple risk factors might benefit from earlier and more aggressive intervention when symptoms first appear. Those with strong family histories should discuss prolapse screening with their doctors even before symptoms develop.

High-risk women who are still having children can work with their doctors to minimize additional pelvic floor trauma during future pregnancies and deliveries. Pelvic floor physical therapy during and after pregnancy, careful management of labor, and consideration of cesarean delivery in certain situations all help protect already vulnerable pelvic floors.

Women at any risk level benefit from basic pelvic floor maintenance. Regular exercises, healthy lifestyle habits, and attention to early warning signs serve you well regardless of your genetic background or obstetric history. Prevention is always easier than treatment, and small efforts now can save significant problems later.

Your risk factors tell a story about your pelvic floor vulnerability, but they don't write the ending. Armed with knowledge about your personal risk, you can take steps to protect your pelvic health and enjoy life without the limitations that prolapse can bring.

Concerned About Your Risk?

Join the APOPS community forum to connect with other women at various risk levels for prolapse. Share prevention strategies, discuss early symptoms, and get support from thousands of women taking control of their pelvic health.

You're not alone. We're here to help.