Your guide to understanding pelvic organ prolapse

Overview

Pelvic organ prolapse occurs when one or more organs in the pelvic area, such as the womb, bladder or bowel, slip down from their normal location and bulge into the vagina. The condition is not life threatening, however it can cause pain as well as other problems. We take a look the different types of pelvic organ prolapse, their causes, symptoms and treatments.

What is a pelvic organ prolapse?

A pelvic organ prolapse occurs when the muscles and ligaments that support the organs in your pelvic area become weak. These organs, such the womb, bladder and bowel, can then slip down from their natural position, creating a bulge in the vagina. This bulge is called a prolapse.

The condition is more common with women who have been through childbirth or have undergone a hysterectomy. It is also common in women who gone through the menopause. 

A pelvic organ prolapse is not life threatening, although it can cause pain and discomfort.

What are the types of pelvic organ prolapse?

There are four main types of pelvic organ prolapse. Each is dependent on the organ affected: 

• Anterior prolapse: This occurs when the bladder bulges into the front wall of the vagina
• Uterine prolapse: The womb bulges into or hangs down in the vagina
• Vaginal vault prolapse: The top of the vagina sags. This can happen after surgery to remove the womb
• Posterior wall prolapse: The bowel bulges forward into the back of the vagina (this is also called the posterior vaginal wall)

Sometimes you may see this called a posterior pelvic organ prolapse or a posterior vaginal prolapse. You can have more than one type of prolapse at the same time. The severity of the prolapse also is classified on a scale of one to four, with four being the most severe.

What causes a pelvic organ prolapse?

The pelvic organs are supported by a group of muscles and tissues that work in a similar fashion to a hammock. When these muscles, more commonly known as the pelvic floor, become weak then the organs that they support can start to shift from their natural positions in the body.

A prolapse occurs when the muscles and tissues can no longer support the organs, causing one or more pelvic organs to drop or press into or out of the vagina.

These organs include the bladder, womb (uterus) and rectum, which is part of the bowel.

There are several reasons why your pelvic floor might become weakened and increase your chance of having a pelvic organ prolapse. These are:

• Age: you are more likely to have a prolapse as you get older, particularly if you are going through the menopause
• Childbirth: this is a common cause of pelvic organ prolapse, particularly if you have had multiple babies or a large baby. A long labour or difficult birth can also cause a prolapse
• Being overweight: you are more prone to a prolapse if you are significantly overweight
• Hysterectomy: This is a surgical procedure to remove the womb, which can lead to an organ prolapse

Some health conditions can also cause a prolapse. These include:

• A long-term health condition, such as a cough, that causes you to strain, or long-term constipation or difficult bowel movements
• Joint hypermobility syndrome, which means your joints are looser than normal
• Marfan syndrome, which is a disorder that affects the body’s connective tissues. These tissues help to support internal organs
• Ehlers-Danlos syndromes, a group of rare inherited conditions that affect the connective tissues

What are pelvic organ prolapse symptoms?

For some women, the pressure from a pelvic organ prolapse can be felt or seen. You may feel an uncomfortable pressure in your vagina during a physical activity or during sex. The most common pelvic organ prolapse symptoms are: 

• Feeling or seeing a bulge or lump in or coming out of your vagina.
• Feeling like there is something coming down into your vagina. 
• A feeling of pressure, discomfort or aching in the pelvis. 
• Difficulty when urinating. This includes urinary incontinence, such as leaking urine or feeling like your bladder is not fully empty.

How do you diagnose pelvic organ prolapse?

If you are experiencing any of the symptoms of a prolapse then you should see your doctor. They will ask if they can do an internal pelvic examination.

The doctor will feel for any lumps inside your vagina and around your pelvic area. They may use an instrument called a speculum to help them to see if there is a prolapse inside your vagina.

The doctor may refer you to hospital for further tests, particularly if you are having problems with your bladder. These include:

• Urine test for possible infection
• Insertion of a tube into your bladder to help identify any problems

What are the treatments for a pelvic organ prolapse?

Depending on the pelvic organ prolapse stage, you may not need any medical treatment, particularly if it is mild or you are not experiencing any symptoms. However, some lifestyle changes will still help you. These include:

• Avoid heavy lifting
• A healthy diet to prevent constipation
• Losing weight if you are overweight

For more severe pelvic organ prolapses or if the symptoms are affecting your daily life then there are a range of treatments available. These are dependent upon the severity of the prolapse, your age and overall health. The treatments include:

• Pelvic floor exercises: (Kegel exercises): these will help to strengthen your pelvic floor muscles.
• Vaginal pessaries: a rubber or silicone device is inserted into the vagina to support the vaginal walls and pelvic organs. These can be used to treat moderate or severe cases and are a good option if you want to avoid surgery.
• Hormone treatment: this involves a treatment with oestrogen, which can help ease some of the symptoms, such as discomfort during sex.

If the prolapse is severe or non-surgical options have not worked, your doctor may suggest surgery. There are several types of surgery.

Surgical repair: This covers a variety of procedures that involve lifting and supporting the pelvic organs either by stitching them in place or by making existing tissues stronger. The procedure is performed under a general anaesthetic.

Hysterectomy: This is a surgical procedure that removes the womb. It can help relieve pressure on the walls of the vagina. It is only an option for women who have been through the menopause or do not wish to have any more children.

Closing the vagina: In this procedure, part or all of the vagina is sewn shut. The treatment is only offered to women who have a severe prolapse or when other treatments have not worked.

While all surgical procedures carry some risk, most are successful and you are able to return to normal daily activities after a period of recovery. However, these surgeries do carry some risks, such as:

• Blood loss, which may require a blood transfusion. 
• Damage to the surrounding organs, such as the bowel or bladder.
• Infection. You may be given antibiotics during and after surgery to reduce this risk.
• Discomfort during sexual intercourse.
• Vaginal discharge or bleeding
• Further prolapses, which may require more surgery.
• A blood clot. You may be given medicine to reduce this risk after surgery.

Help for pelvic organ prolapse

A consultation with an experienced gynaecologist is often the quickest and simplest way to resolve your problem.

They will be able to diagnose the cause of your pain and talk with you about the best treatment options for your specific situation.

An appointment with an experienced consultant at your nearest Circle Health Group hospital can be helpful. They will assess and diagnose the cause of your symptoms and then discuss any suitable treatment options for your specific situation. To schedule your visit, book a specialist appointment online today.

If you would like to learn more about pelvic organ prolapse, download our Women's Health Matters report.