What is pelvic organ prolapse?
The pelvic organs include the vagin*, uterus, bladder and bowel.
Sometimes the ligaments and muscles that support the pelvic organs stretch and cause these organs to drop down. This is called a ‘pelvic organ prolapse’.
There are different types of pelvic organ prolapse, including uterine prolapse and bladder and bowel prolapse (vagin*l prolapse).
Uterine prolapse
A uterine prolapse is when the uterus (womb) and cervix (the opening to the uterus) drop down towards the vagin*l entrance and may even protrude outside the vagin*.
Bladder and bowel prolapse (vagin*l prolapse)
Bladder prolapse (cystocele) is when the bladder bulges into the front wall of the vagin*.
Bowel prolapse (rectocele) is when the rectum bulges into the back of the vagin*l wall.
Bladder and bowel prolapses usually happen together, but they can happen on their own. This type of prolapse is also known as ‘vagin*l prolapse’ because the walls of the vagin* become overstretched and bulge down towards the vagin*l entrance.
Symptoms of a prolapse
The symptoms of a prolapse depend on the severity of the prolapse and your general health.
Symptoms can include:
- needing to wee more often or straight after weeing
- needing to go to the toilet quickly
- inability to control your wee or poo (incontinence)
- inability to completely empty your bladder or bowel when going to the toilet
- straining to wee or poo
- a slow flow of wee that may stop and start.
There may also be:
- a feeling of fullness or pressure inside the vagin*
- a sensation of vagin*l ‘dragging’ or ‘heaviness’
- a feeling of swelling or a lump at the vagin*l opening.
In severe cases, the vagin*l wall or cervix may protrude outside the vagin*l entrance.
What causes a prolapse?
Anything that puts pressure on your pelvic floor muscles can cause a prolapse.
For example:
- pregnancy and childbirth
- regularly straining when trying to do a poo
- being overweight or obese
- coughing due to smoking or chronic lung disease
- repetitive lifting of heavy weights at work, home or the gym.
The risk of prolapse increases:
- with previous pelvic or gynaecological surgery
- if you have a connective tissue disorder (such as Ehlers Danos syndrome or Marfan’s syndrome)
- after menopause when oestrogen levels drop, causing pelvic floor muscles to lose elasticity.
Note that being sexually active does not cause or worsen prolapse.
Diagnosing prolapse
Prolapse is usually diagnosed by your doctor after discussing your symptoms and medical history. They will also do a physical pelvic examination to check:
- the degree of prolapse
- how well the pelvic floor muscles are working
- which organs are involved in the prolapse.
Other tests
You may also need other tests including:
- a pelvic ultrasound – to check for masses or cysts
- a bladder function test (urodynamics) – to check for different types of incontinence
- a bladder scan – to check if urine is left in the bladder (residual urine) after going to the toilet
- a midstream urine test – to check for a urinary tract infection (UTI).
Stages of prolapse
The severity of prolapse is measured using the POP-Q system to understand the stages of prolapse. Stages 1 to 4 are defined by how far the prolapse comes down into the vagin*.
Treatment and management
Without intervention, symptoms of prolapse will usually get worse over time. Treatment and management will depend on the severity of the prolapse and how much it interferes with your daily life.
Prevention
Pelvic floor exercises, healthy lifestyle changes and achieving a healthy weight may be all you need to prevent a prolapse.
Mild and moderate prolapse
If you have a mild or moderate prolapse (stages 1 and 2), regular sessions with a pelvic floor physiotherapist will help.
If the prolapse is more severe, you may need to try different approaches, including pessaries or surgery.
Pessaries
A pessary is a device that health professionals insert into your vagin* to support the pelvic organs. They are a non-surgical way of managing prolapse. Pessaries are available in different shapes and sizes. The most common type is a ring pessary.
Surgery
In severe cases, or when other options haven’t helped, surgery may be necessary. This is usually done under general anaesthesia, but it can also be done with spinal anaesthesia.
Surgery may involve removing excess tissue and repairing your vagin* with dissolvable or permanent stitches. Surgery may also involve reinforcing the connective tissues in your pelvis (i.e. between the bladder, vagin* and bowel). In some cases, surgery may involve removing your uterus (hysterectomy).
What you can do
There are practical things you can do to reduce the risk of prolapse. These may also help you to recover well after a prolapse or surgery.
Lifestyle changes such as stopping smoking, managing constipation and avoiding heavy lifting will help. Regular physical activity, a healthy diet and weight management may also help.
Doing pelvic floor exercises every day is also important, including squeezing up pelvic floor muscles before lifting, coughing, laughing and sneezing. A pelvic floor physiotherapist can show you how to do this.
More information
For more detailed information, related resources, articles and podcasts, visit: jeanhailes.org.au/health-a-z/vulva-vagin*/vulva-and-vagin*
Where to get help
- Your GP (doctor)
- Gynaecologist
- Pelvic floor physiotherapist
- Jean Hailes for Women’s Health Tel. 1800 JEAN HAILES (1800 532 642)
- Continence Foundation of Australia Helpline Tel. 1800 33 00 66
