Pelvic organ prolapse

Pelvic organ prolapse happens when one or more of the pelvic organs (your womb, bladder or bowel) slip from their usual position. When this happens, the vaginal wall bulges into the vagina, or out of it.

Prolapse isn't life-threatening, and some women have little or no trouble from it. In more severe cases, though, it can feel very uncomfortable. It might stop you doing the things you enjoy and affect your quality of life. Like incontinence, prolapse isn't an inevitable part of ageing.

If you think you might have a prolapse, speak to your doctor. You don't need to suffer or feel embarrassed. Many women experience pelvic organ prolapse, and it can be treated.

Some women with pelvic organ prolapse have no symptoms at all. The condition may only be found during an internal examination done for another reason, such as a cervical screening test (smear test). Other women do notice symptoms, and it's normal for your symptoms to feel more or less severe at different times of the day.

Speak to your doctor if you think you might have a pelvic organ prolapse, or if you notice symptoms such as:

• a feeling of a bulge or something coming down the vagina
• a feeling of a bulge or something coming out of the vagina, which sometimes needs to be pushed back up (you may be able to see this with a mirror)
• discomfort during sex
• problems peeing, such as a slow stream, a feeling that your bladder hasn't emptied fully, needing to go to the toilet a lot, or leaking

Pelvic organ prolapse is a common condition. If you see your doctor early, it may be easier to manage.

Your doctor will need to do a pelvic examination, and that includes an internal examination of your vagina. The doctor will talk you through it first, 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. If you prefer, you can ask for a female doctor or health professional.

The internal examination is similar to a smear test and should only take a few minutes. If your doctor thinks you need any further tests, they will discuss that with you.

Pelvic organ prolapse can affect the front, top or back of the vagina. The main types are:

• anterior prolapse (cystocele), where 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), where the womb and / or cervix bulges down into the vagina
• 'vault' prolapse, which can happen after a total hysterectomy, when the new 'top' of the vagina bulges downwards
• posterior wall prolapse (rectocoele or enterocoele), where the bowel bulges forward into the back wall of the vagina

You can have more than one of these types of prolapse at the same time.

Doctors usually describe how severe a pelvic organ prolapse is with a number from 1 to 4. A 4, for example, means a severe prolapse. You can ask your doctor what the number means for you, and any other questions you have.

Pelvic organ prolapse usually doesn't have one single cause. Several things can raise your risk of developing it:

• 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, which is linked 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

There are some things you can do to lower your risk of pelvic organ prolapse.

• do regular pelvic floor exercises to strengthen your pelvic floor muscles
• keep to a healthy weight
• eat a high-fibre diet, so you avoid constipation and straining when you go to the toilet for a poo
• adopt good toilet habits
• avoid heavy lifting

What treatment you need for pelvic organ prolapse depends on how much it gets in the way of your normal day to day activities.

If the prolapse is mild, your doctor may suggest a few changes to your daily habits. These include doing pelvic floor exercises regularly and keeping to a healthy weight.

A vaginal pessary is a device that goes inside your vagina. It holds the vaginal walls in place, and that pushes the prolapse back. Most pessaries are made of latex (rubber) or silicone, and they come in different shapes and sizes.

A pessary might not suit everyone. Your doctor will talk it through with you to see whether it's the best option, and you can ask whatever questions you 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 notice any of these symptoms, speak to your doctor. They can usually be treated.

Hormone replacement therapy (HRT) replaces the female hormones that drop to a lower level during the menopause.

There's little evidence that HRT can treat pelvic organ prolapse directly. It can, though, ease some of the symptoms that come with it, such as vaginal dryness or discomfort during sex. Depending on your symptoms, you may want to ask your doctor whether HRT would be a suitable treatment option for you.

Depending on your circumstances and how severe your symptoms are, your doctor may talk with you about whether surgery could help with pelvic organ prolapse. They will go through the options with you.

It's ok to ask any questions about your care, so you get the information you need. You can then take some time to decide which option is best for you.

Don't include personal information such as your name, location or any personal health conditions.