Pelvic organ prolapse
The female pelvic organs are held in place by ligaments, muscles and skin. These structures can weaken and result in a prolapse (‘falls out of place’) of the uterus, urethra, small bowel, rectum (large bowel), bladder and vagina.
The most common types of prolapse seen in women involve the womb (uterine prolapse), or bladder (cystocoele) or bowel (rectocoele). These are all caused by weakness in the pelvic floor muscles and ligaments holding the womb and top of thevagina in place. The prolapsing organ bulges into the vagina, causing a variety of symptoms. After a hysterectomy (operation to remove thewomb), the top of the vagina can bulge downwards. This is called a vaginal vault prolapse.
Prolapse can happen at any age but is more common after the menopause, due to loss of oestrogen. A prolonged labour, vaginal delivery of a very large baby, smoking and being overweight all increase the risk.
Symptoms
- A feeling of ‘pulling down’ or dragging in the pelvis
- A bulge in the vagina
- Difficulty completely emptying the bladder (bladder prolapse), sometimes requiring either standing or placing fingers into the vagina to press on the front wall to help
- Difficulty completely emptying the bowel (bowel prolapse), sometimes requiring placing of fingers into the vagina to press on the back wall to help
- Difficulties during intercourse including discomfort and pain
How Is Pelvic Organ Prolapse Diagnosed?
A prolapse is suspected from the symptoms, and confirmed by a doctor performing a vaginal examination. This is the type of examination from a smear test, but you may also be asked to lie on your left side in order to view the prolapse. The prolapse will be graded based on how big the bulge is, usually as grade 1, 2 or 3 (mild, moderate or severe). A prolapse cannot be diagnosed using an ultrasound scan.
How Is It treated?
A mild prolapse can be treated with exercises to strengthen the pelvic floor muscles. As well as helping to improve the prolapse, pelvic floor exercises also help treat urinary incontinence. Pelvic floor exercises should be continued for life.
Larger prolapses, or prolapses causing symptoms and affecting quality of life, can be treated using either vaginal pessaries (rubber or silicone ring shapes to hold the prolapse in place) or surgery. If you have a lot of other medical problems, a pessary may be the best and safest option.
Surgery is usually offered if the pessary has failed, it is too uncomfortable or it is affecting a woman’s sex life. The type of surgery depends on the type of prolapse involved, but may include a vaginal repair, a vaginal hysterectomy, or sometimes keyhole surgery to hitch up the prolapse internally. In women who have had surgery for a prolapse, one to two in ten will have a recurrence.
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