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Your guide to understanding pelvic organ prolapse

According to National Institute for Clinical Excellence (NICE), pelvic organ prolapse affects up to 50% of women in the UK. Sadly, one in 10 of these women will need at least one surgical procedure. We explain what pelvic organ prolapse is, the symptoms it can cause and how it can be diagnosed and treated. 

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

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.

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

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.

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.
  • 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:

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.

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

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:

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.

Vaginal mesh surgery: In this procedure, a piece of synthetic mesh is inserted to hold the pelvic organs in place. The mesh, which looks similar to a net, stays in your body permanently. The procedure is performed under a general anaesthetic. A few women have reported complications after vaginal mesh surgery. These include:

  • Nerve damage
  • Pain
  • Incontinence
  • Constipation
  • Sexual problems

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:

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 BMI 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.

We partnered with pioneering research charity Wellbeing of Women to produce our Women's Health Matters 2021 report. Wellbeing of Women help improve pregnancy care, IVF outcomes and the risk of childbirth complications for women through their ground-breaking research.

Women's Health Matters 2021 provides a comprehensive analysis of ten of the most common gynaecological conditions misdiagnosed or misunderstood for years at a time. Infertility, debilitating chronic pain, the onset of associated conditions and severe depression are common effects of living with a gynaecological condition without access to the right care. Yet despite this, education and awareness around women’s health is lacking.

Millions of women in the UK continue to suffer in silence while waiting for a diagnosis, unsure of how best to manage their pain or seek help.

The aim of this Women's Health Matters is to tackle taboos in women's health by sharing the hard-hitting stories of other women living with these conditions, as well as:

  • Insightful commentary by specialist Consultant gynaecologists;
  • Information about what to look out for, diagnostic testing and effective treatment options for each condition;
  • Links to trusted support networks across a range of conditions;
  • Expert insight shared by Wellbeing of Women, ground-breaking research charity and advocate for increased awareness of women's health; and
  • Much more. 

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