Pelvic organ prolapse

What is prolapse?

This common condition refers to the bulging or herniation of the uterus or other pelvic organs such as the bladder or bowel into or out of the vagina.

Symptoms of prolapse include:

• Heavy dragging feeling in the vagina or a lump in or outside the vagina
• Urinary problems such as poor stream, a feeling of incomplete bladder emptying, urinary frequency or urgent desire to pass urine, and urinary stress incontinence
• Bowel problems, such as difficulty opening the bowel or a feeling of not emptying properly
• Problems with sexual intercourse

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Prolapse may be the consequence of damage to or weakening of the nerves, muscles, ligaments and fascia (a network of supporting tissue) that support the pelvic organs and hold them in a correct position. One of the following may be a contributing factor:

• Pregnancy and childbirth: these are considered to be major factors leading to weakening of the vagina and its supports. Prolapse affects about one in three women who have had one or more children. A prolapse may occur during or shortly after a pregnancy or may take many years to develop. However, it is important to emphasise that only one out of ten women (11%) will ever need surgery for prolapse in their lifetime.
• Ageing and menopause: may cause weakening of the pelvic floor structures.
• Conditions that cause excessive pressure on the pelvic floor like obesity, chronic cough, chronic constipation, heavy lifting and straining.

Once you have established what a prolapse is and whether you have one. Treatment options for a prolapse should be tailored according to life circumstances such as intended further pregnancies, sexual activity or medical conditions. The treatment choices can be categorised into conservative (non-surgical) and surgical options.

Conservative treatment options for pelvic organ prolapse

Lifestyle changes:

Prolapse is not a life-threatening condition and many women will choose not to have any treatment if they have no significant symptoms or discomfort and are able to continue with day-to-day activities. If you have been diagnosed with a prolapse, excessive pressure on the pelvic floor is not recommended. You should try to avoid heavy lifting, chronic straining e.g. with constipation, and gaining excess weight.

Pelvic floor exercises (Kegel exercises):

Performing regular pelvic floor muscles may help to improve or prevent the worsening of prolapse, especially at early stages of the condition. Like any exercise programme, pelvic floor exercises require appropriate technique, motivation and repetition of exercises for best results. For the best outcomes, input from a dedicated Women’s Health Physiotherapist is recommended.

The exercises also have a role in preventing the recurrence of prolapse following surgery.

Please see the pelvic floor exercises section for more information.

Vaginal pessary

Pessaries are plastic removable devices inserted in the vagina to help alleviate prolapse symptoms. They provide mechanical support to the prolapse organs in the vagina such as the uterus or bladder. They come in various shapes and sizes. Usually a period of trial and error is required until a suitable pessary is found. They are best suited if you wish to avoid surgery, for example due to a medical condition or anaesthetic concerns. They are also suitable if you wish to delay surgery for a pregnancy or for other reasons. Sexual activity can be possible with certain types of pessaries. Pessaries need to be checked and replaced at six-monthly intervals.

Please see the vaginal pessary section for more information.

Surgical treatment options for pelvic organ prolapse

Surgery is recommended if there is significant symptomatic pelvic organ prolapse which cannot be resolved by any of the conservative treatments above. Surgery for prolapse is relatively common, with almost one in ten women undergoing it by the time they reach 80 years old.

There is a variety of surgical options for women with prolapse symptoms and the recommended treatment will depend on the type and the severity of the prolapse and any relevant medical and surgical history.

Surgical options include vaginal repair, vaginal hysterectomy, uterine-preserving prolapse surgery and pelvic floor and perineal reconstruction. Most of these procedures are performed using minimal invasive techniques, either vaginally or through keyhole surgery (laparoscopy).

Please see the surgery section for more information.