Pelvic organ prolapse

About pelvic organ prolapse

The pelvic organs (bladder, vagina, uterus and rectum) are normally held in place by ligaments and muscles (commonly known as the pelvic floor). If these supportive structures stretch, the pelvic organs can bulge (prolapse) from their usual position into or even outside of the vagina.

Prolapse is very common affecting about 40% of women who have had children.
Symptoms of a prolapse include a feeling of vaginal heaviness or something ‘coming down’.
A bulge may be seen or felt inside or outside the vagina.
A prolapse may also cause some bladder and bowel symptoms or impact onto sexual activity however these may be unrelated to the prolapse.
It is possible to have a prolapse and not experience any symptoms from it.
A prolapse can vary day to day, week to week and may depend on what activities you have been doing.

Differerent types of prolapse

There are different types of prolapse and it is possible to have more than one type:

Front wall prolapse - The wall supporting the bladder bulges into the vagina.
Back wall prolapse - The wall supporting the rectum bulges into the vagina.
Uterine prolapse - The uterus moved downwards into the vagina.
Vaginal vault prolapse - After a hysterectomy, the top of the vagina (the vault) bulges downwards.

Prolapse symptoms

Learn about the different prolapse symptoms

Prolapse symptoms can vary greatly and you may not even be aware that you have a prolapse.
You may feel a lump coming down in your vagina, or a heavy, dragging sensation.
You may be able to see or feel a lump or a bulge. This may be inside your vagina but may come outside of your vagina.
Symptoms can often be worse if you have been standing or on your feet for a long time or at the end of the day.
If the front wall is ‘lax’ you may experience the need to pass urine more frequently, it may be more difficult to pass urine or feel that you can’t empty your bladder fully. Some women experience frequent urinary infections and some find they may leak with activity.
If the back wall is ‘lax’ you may struggle to empty your bowel fully. You may feel the need to support around the back passage with your fingers to help pass stools. Some women experience wind leakage or staining/smearing around the back passage.
Prolapse can cause back, abdominal or vaginal discomfort but this is not normally the main symptom.
Prolapse can cause a feeling that intercourse is ‘blocked’ due to something in the vagina or can be uncomfortable. Women may worry that having sex can be harmful to the prolapse but this is not the case. Using a suitable lubricant can be very helpful and trying different positions for comfort.

Management options

If you have a prolapse the following may be options for you:

Do nothing and monitor your symptoms

Adopt good bladder and bowel habits

Bladder habits include:

taking your time when going to the toilet
not straining to ‘push’ the wee out
rocking forwards and backwards at the end of emptying your bladder to make sure it drains fully
not going to the toilet ‘just in case’, and instead waiting until you feel the need to go
drinking adequate fluids, the recommendation is 1.5 to 2 litres per day
sitting fully on the toilet rather than ‘hovering’

Bowel habits include:

placing your knees apart and feet on a small stool
keeping your tummy and breathing relaxed
supporting the area between the front and back passage or vaginally on the bulging wall can assist opening your bowel
a slight bearing down rather than a big strain can be a better way of emptying your bowel

Lifestyle changes

Lifestyle changes include:

maintaining a healthy weight
avoiding constipation by eating and drinking adequate fibre and fluids
trying to limit the weight and frequency of lifting, and contracting your pelvic floor muscles when you have to lift. Breathing out as you lift can also help reduce the pressure within your abdomen
managing a chronic cough by taking appropriate medication or if you smoke consider stopping or reducing

Activity and exercise

Pelvic floor exercises

The pelvic floor muscles form a hammock underneath your pelvis to provide support to your pelvic organs. These muscles are affected by hormonal changes and may be damaged as a result of childbirth, pelvic surgery, persistent heavy straining due to constipation, a chronic cough, repetitive heavy lifting and from being over weight.

Improving the strength and function of the pelvic floor muscles by regular exercises can provide better support for the pelvic organs and make the symptoms from a prolapse less bothersome.

Vaginal oestrogen

Surgery

There are a variety of operations available for prolapses. These can be discussed with a urogynaecology consultant surgeon alongside the risks and benefits of each type of surgery. Depending on the type of surgery it may be done abdominally or vaginally.

Post-surgery every woman is different in her speed of recovery.
It is normal to feel tired for several weeks, rest when you need to.
You can start gentle pelvic floor exercises as soon as you are comfortable to do so. This can help with the healing process as it improves blood flow to the area.
For the first 2 weeks avoid lifting anything heavier than a kettle of water.
Bin bags, toddlers, shopping and laundry should not be lifted for at least 6 weeks. Then remember to gently activate your pelvic floor muscles during a lift.
Increase your walking as you feel able, aiming to be walking 1.5 hours per day by week 6 of your operation.
Swimming may be restarted after about the 5th week, when any bleeding has stopped but build up slowly.
More strenuous sports should not be re-started until after your check up in clinic.

Need more help?

Consider self referring using the link below:

If you have a new injury or problem, please look at the self help information in our advice pages. We will often complete the same exercises and share information in clinic appointments.

If you still need some more help you can self refer into our service. Please note that the NHS is currently experiencing longer than normal waits, for more information visit our waiting times page.

Refer yourself to physiotherapy