Pelvic organ prolapse
Pelvic organ prolapse
Pelvic organ prolapse happens when one or more organs in the pelvis (the womb, bladder or bowel) shift out of their normal position. This can cause the wall of the vagina to bulge inward, or even out through the vaginal opening.
This condition is not life-threatening. For some women it causes little or no trouble at all. For others, especially in more severe cases, it can feel quite uncomfortable and may get in the way of daily activities or things they enjoy, affecting overall quality of life. Just like urinary incontinence, prolapse is not something you simply have to accept as a normal part of growing older.
If you think you may have a prolapse, talk to your doctor. There is no need to suffer in silence or feel embarrassed about it. Prolapse is common among women, and effective treatment is available.
Common Symptoms
Symptom information is not available for this condition yet.
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
Causes
There isn’t usually one cause, but the risk of developing pelvic organ prolapse is increased by:
- age – prolapse is more common as you get older, but it’s not an inevitable part of ageing
- childbirth – particularly if you had a long or difficult labour, or have given birth to a large baby or multiple babies
- menopause – related to lower levels of oestrogen or weaker tissue
- being overweight
- having large fibroids or pelvic cysts which create a lot of pressure in the pelvis
- previous surgery on the pelvis – such as a hysterectomy
- repeated heavy lifting or manual work
- long term coughing or sneezing (caused by smoking, a lung condition or allergies)
- straining too much when going to the toilet for a poo because of long term constipation
Diagnosis
A prolapse is a common condition, and seeing your doctor early can make it easier to manage.
Your doctor will need to do a pelvic examination, which includes an internal examination of your vagina. Your doctor will explain what this involves beforehand, and you can ask any questions you have.
Because this is an intimate examination, the doctor may have another person (a chaperone) in the room with you. If you would prefer a female doctor or health professional, you are welcome to ask for one.
The internal examination is similar to a smear test and usually takes only a few minutes. Your doctor will let you know if any further tests are needed.
Types of prolapse
Pelvic organ prolapse can affect the front, top or back of the vagina. The main types are:
- anterior prolapse (cystocele): the bladder bulges into the front wall of the vagina
- prolapse of the womb and/or cervix (the opening between the vagina and the womb): the womb and/or cervix bulges down into the vagina
- vault prolapse: this can happen after a total hysterectomy, where the new top of the vagina bulges downwards
- posterior wall prolapse (rectocoele or enterocoele): the bowel bulges forward into the back wall of the vagina
It is possible to have more than one of these types of prolapse at the same time.
Doctors usually describe how severe a pelvic organ prolapse is using a scale of 1 to 4, with 4 meaning a severe prolapse. You can ask your healthcare professional what this grading means for your own situation, along with any other questions you may have.
Treatment
Treatment
Treatment will depend on how much the issue is affecting your normal day to day activities.
In mild cases of prolapse, your doctor may recommend lifestyle changes. For example, regular pelvic floor exercises and maintaining a healthy weight.
Vaginal pessary
A vaginal pessary is a device inserted into your vagina, which holds your vaginal walls in place and so pushes the prolapse back. Pessaries are usually made of latex (rubber) or silicone, and come in different shapes and sizes.
A pessary might not be right for everyone. Your doctor will discuss with you to find out if it’s the best option, and you can ask any questions you may have. Some side effects can include:
- vaginal discharge
- irritation, bleeding or sores inside your vagina
- stress incontinence
- difficulty with bowel movements
- difficulty having sex (although most women can have sex without problems)
- an imbalance of the usual bacteria found in your vagina
If you have a pessary and experience any of these symptoms, speak to your healthcare professional. They can usually be treated.
Hormone Replacement Therapy (HRT)
HRT replaces the female hormones that are at a lower level as you experience the menopause.
There is little evidence that HRT can directly treat pelvic organ prolapse, but it can relieve some of the symptoms associated with it. For example, vaginal dryness or discomfort during sex. Depending on your symptoms, you may wish to ask your doctor for more advice on whether this would be a suitable treatment option for you.
Surgery
Depending on your circumstances and how severe your symptoms are, your doctor may discuss with you whether a surgery might be helpful. They will go through the options with you.
It’s ok to ask any questions about your care to help you get the information you might need. You can then take some time to decide what the best option is for you.
Don’t include personal information e.g. name, location or any personal health conditions.
Prevention
There are things you can do to help lower your risk of pelvic organ prolapse.
Working on your pelvic floor
What helps:
- Doing regular pelvic floor exercises to keep these muscles strong
- Staying at a healthy weight
- Eating a high-fibre diet so you avoid constipation or straining when you pass stool
- Building good toilet habits
- Steering clear of heavy lifting