Pelvic Organ Prolapse

The organs within a woman’s pelvis (uterus, bladder and bowel) are held in position by ligaments and muscles.

If these support structures are weakened, the pelvic organs can bulge or ‘prolapse’ into the vagina causing a pelvic prolapse.

Sometimes a prolapse may be large enough to be seen or felt as a lump or bulge at the vaginal opening or outside the vagina.

Prolapse is very common after pregnancy and childbirth and can be highly bothersome.

Even after surgery to mend prolapse, one in three women will prolapse again.

Prolapse can also happen in women who have had their womb removed (that is, had a hysterectomy). In a case like this, the top of the vagina (the vault) can prolapse.

Why does this occur?

There are many ‘risk factors’ for the development of pelvic organ prolapse which include:

  • Genetic predisposition

  • Excessive weight gain (High BMI)

  • Constipation and straining

  • Repeated heavy lifting

  • Childbirth - especially instrumental childbirth (forceps delivery), baby over 4kg

  • Risk increases with the number of vaginal births

  • Chronic coughing

  • Previous prolapse surgery

  • Previous hysterectomy

The reason these things cause prolapse is primarily because they weaken, stretch or alter the pelvic floor muscle and connective tissue strength and integrity.

What are the signs and symptoms?

Women with mild prolapse may have no symptoms or discomfort at all.

Symptoms that may occur are:

  • A heavy sensation or dragging in the pelvis or vagina

  • You may be able to see or feel a lump or bulge coming from the vagina when you are in the shower or having a bath

  • Lower back pain that eases when you lie down.

  • Your bladder might not completely empty or your urine -the stream might be weak

  • Urinary tract infections might be reoccurring

  • Difficulty emptying your bowel

  • Pain or lack of sensation during sex

What can be done to help me?

Evidence shows a correct pelvic floor technique assessed by a Pelvic Floor Physiotherapist combined with individualised program pelvic floor program can significantly reduce prolapse symptoms.

On top of this we can also provide expert advice regarding reducing aggravating factors and modifying general exercise programs which is essential in reducing prolapse symptoms.

A Pessary is another form of management for prolapse symptoms. In some cases we are able to fit you with a pessary and provide ongoing management of pessary use. In some situations, we may also suggest that your pessary is managed by a gynaecologist/specialist GP.

Even if you are considering surgery, it is important to note if you have not addressed your prolapse ‘risk factors’ it is likely that your prolapse will come back. Having a strong pelvic floor, controlling body weight and learning about correct lifting mechanics and safe exercise techniques are incredibly important in ensuring your surgery doesn’t fail.