Pelvic Organ Prolapse

Pelvic organ prolapse happens when the muscles and connective tissues that support the organs in the pelvis become weak or stretched, allowing one or more organs to drop down from their normal position. The bladder, womb (uterus), top of the vagina, or bowel can bulge into or out of the vagina.

Prolapse is common, particularly in women who have given birth and after the menopause. It is usually not a dangerous condition, but it can be uncomfortable and affect daily life, and symptoms can sometimes be improved or relieved with treatment.

Prolapse is often described by which organ is involved. The bladder bulging into the front wall of the vagina is one of the most common types. The bowel can press into the back wall of the vagina, and the womb or, after a hysterectomy, the top of the vagina can drop down.

More than one type can occur at the same time. The degree of prolapse varies from mild, where it causes few or no symptoms, to more advanced, where a noticeable bulge may be felt or seen.

Common symptoms include a feeling of heaviness, dragging, or pressure in the lower abdomen or vagina, and the sensation or sight of a bulge or lump in or coming out of the vagina. Some women notice discomfort during sex.

Prolapse can also affect bladder and bowel function, leading to a feeling of not fully emptying the bladder or bowel, needing to pass urine more often, leaking urine, or difficulty with bowel movements. Symptoms often feel worse after standing for a long time or at the end of the day and may ease when lying down. Some women have a prolapse with no symptoms at all.

Prolapse develops when the support for the pelvic organs is weakened. Pregnancy and childbirth, especially vaginal births, are common contributing factors. The drop in oestrogen around the menopause and the natural effects of ageing can also weaken supporting tissues.

Other factors that increase pressure in the abdomen over time can contribute, including being overweight, long-term constipation and straining, a long-term cough, repeated heavy lifting, and previous pelvic surgery such as a hysterectomy. Often several factors combine.

Prolapse is usually diagnosed through a discussion of symptoms and an internal pelvic examination, during which a clinician can see and feel which organs are affected and how far they have descended. You may be asked to cough or bear down so the prolapse can be assessed.

Most women do not need further tests. If there are bladder or bowel symptoms, or if surgery is being considered, additional tests such as bladder function studies or imaging may sometimes be arranged. The examination also helps rule out other causes of the symptoms.

Treatment depends on the type and severity of the prolapse, the symptoms, and personal preferences. For mild prolapse, or as a first step, lifestyle measures and pelvic floor muscle exercises can help, often guided by a specialist physiotherapist. Reaching a healthy weight, treating constipation, and avoiding heavy lifting can reduce strain.

A vaginal pessary, a removable device placed in the vagina to support the organs, is a common non-surgical option that can relieve symptoms. For more troublesome prolapse, or when other measures have not helped, surgery may be considered to support or repair the affected area. A clinician can explain the benefits and risks of each option so a woman can choose what suits her.

Not all prolapse can be prevented, but some steps may lower the risk or slow it: doing regular pelvic floor exercises, keeping a healthy weight, eating enough fibre and drinking fluids to avoid constipation and straining, and using good technique or getting help with heavy lifting. Treating a persistent cough can also help.

The outlook is generally reassuring. Prolapse is rarely dangerous, and many women find their symptoms improve with conservative measures, a pessary, or surgery. Because prolapse can change over time, ongoing symptoms are worth discussing so the management plan can be adjusted.