Pelvic organ prolapse

What is it?

A prolapse is the name used when the vaginal walls have somewhat collapsed.  The organs in the pelvis push on the collapsed walls.  There are 3 different types of prolapse and you can have any of these or a combination of them.

A rectocoele

This is when the back wall of the vagina collapses and bowel pushes on the vaginal wall.

A uterine prolapse

The top wall of the vagina collapses and the uterus starts to push on the wall.

A cystocoele

This is when the front wall of the vagina collapses and the bladder starts to push on the wall.

These things are all more likely to happen as you age, after childbirth, if you are constipated and if you do anything which increases the pressure in your abdomen frequently.


How will I know I have one?
  • A prolapse may give you no symptoms at all and your doctor or nurse may mention it when they are doing a smear test.
  • You may feel a dragging sensation in your pelvis or a feeling like you are bearing down.
  • Sometimes you will have problems passing urine.
  • You may notice a lump in your vagina after opening your bowels or when lifting something.
  • You may notice a lump outside your vagina when washing/drying yourself. Often you can push the lump back inside, but it may come out again by itself or if you are lifting things or going to the toilet.
How will it be diagnosed?
  • Your doctor will examine you and may ask you to bear down during an internal examination. This allows them to feel if there is any pressure on the vaginal walls if a prolapse is not initially obvious.
  • You may also be asked to do a urine sample if you are having problems passing urine to make sure you don’t have a urine infection.
What happens next?
  • The aim of treatment is to reduce any discomfort, make sure you can open your bowels and pass urine properly, reduce the risk of incontinence and make sure you can have sex comfortably.
  • If you want to have children, you should also be able to do so.


You don’t necessarily need to do anything if you are not having any problems.

What can I do?
  • If your BMI is over 35, you may improve things by losing some weight.
  • Your health care provider should be able to explain to you how to do pelvic floor exercises.
  • A physiotherapist who specialises in women’s health can help with pelvic floor training if needed. This is a good idea for any woman with prolapse problems regardless of which treatment she chooses to have.
  • You should avoid becoming constipated, drink plenty of fluids and talk to your doctor if you regularly suffer from constipation.
  • Smoking can aggravate the problem by causing a cough and weakening muscles, speak to you doctor or pharmacist if you want to give up smoking.
  • Avoid heavy lifting where possible and anything which causes you to strain.
Treatments
  • Doctors may suggest a trial of vaginal oestrogen tablets or cream. These can help to ease any discomfort and will usually be trialed for 6 weeks to 3 months alongside pelvic floor exercises.
  • Vaginal pessaries are silicone or plastic devices which can be inserted into the vagina to support the vaginal walls. They are a good option for anyone who would like to avoid surgery if possible. They can also be used for women who haven’t completed their families. They are usually removed and replaced every 6 months. They should not be uncomfortable, and you should be able to do your normal activities, pass urine, open your bowels and have sex with a pessary.
ring pessary
  • I have developed tools to assist with pessary options for patients in my clinic.
pessary fitting guide.
  • Surgery can be used as a long-term treatment for vaginal prolapse but most women will need to do pelvic floor exercises, ensure their BMI is below 30 and they have discussed all options for treatment before taking this route.
  • There are a variety of surgical options and the choice of operation will depend upon your individual condition and the advice and recommendations of your surgeon. Surgeries include vaginal repair (reinforcing the vaginal walls), hysterectomy and operations to lift the uterus or vagina up and fix it in place. Recovery after an operation may take up to 6-8 weeks depending upon the procedure.
Will it come back after treatment?

Sometimes after surgery a prolapse can come back. This is more likely in women who are older and overweight, whilst figures vary it can happen in up to 29% of women.

A final word from Dr Emma Rees.

This post can only give you basic information. It is based on evidence-guided research from the World Health Organization and the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists and National Institute for Health and Clinical Excellence Guidance. Different people may give you different information and advice on certain points.

References

Jelovsek JE, Chagin K, Lukacz ES, et al; NICHD Pelvic Floor Disorders Network. Models for predicting recurrence, complications, and health status in women after pelvic organ prolapse surgery. Obstet Gynecol 2018;132:298-309.

Helping you to choose the method of treatment that is best for you

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