Pelvic organ prolapse

Pelvic organ prolapse is when one or more of the pelvic organs (your womb, bladder or bowel) slip from their usual position. This causes the vaginal wall to bulge into, or out of, the vagina.

Pelvic organ prolapse isn't life-threatening. In some cases it can cause little or no problems. However, in more severe cases, it may feel very uncomfortable. It might stop you doing the things that you enjoy, and affect your quality of life. Like incontinence, prolapse isn't inevitable part of ageing.

Speak to your doctor if you think you might have a prolapse. You don’t need to suffer or feel embarrassed. Many women can experience prolapse, but it can be treated.

Symptoms

Some women with a pelvic organ prolapse don’t have any symptoms at all. The condition may only discovered during an internal examination for another reason. For example, during a cervical screening test (smear test). Other women will experience symptoms. It's normal for your symptoms to feel more or less severe at different times of the day.

Diagnosis

A prolapse is a common condition. Seeing your doctor earlier may help you manage it more easily.

Your doctor will need to carry out a pelvic examination, which will include an internal examination of your vagina. Your doctor will discuss this with you and you can ask any questions that you might have.

As this is an intimate examination, the doctor may have another person (chaperone) present. You can ask for a female doctor or health professional if you prefer.

The internal examination is similar to a smear test and should only take a few minutes. Your doctor will discuss with you if they think any further tests are needed.

Types of prolapse

Pelvic organ prolapse can affect the front, top or back of vagina. The main types of prolapse 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 in to the vagina
• 'vault’ prolapse – this can be as a result of a total hysterectomy where the new ‘top’ of the vagina bulges downwards
• posterior wall prolapse (rectocoele or enterocoele) – when 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.

A number system of 1 to 4 is usually used to describe how severe a pelvic organ prolapse is. For example, a 4 means a severe prolapse. You can ask your healthcare professional what this means for you, and any other questions you may have.

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

Prevention

There are things you can do to reduce the risk of pelvic organ prolapse.

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.