Pelvic Organ Prolapse

Your pelvic organs include your bladder, uterus (womb) and rectum. These organs are held in place by strong tissues(fascia) and ligaments. The fascia and ligaments hold your pelvic organs inside the pelvis along with help from the pelvic floor muscles.

The fascia and ligaments may stretch over time or may tear as a result of childbirth. The pelvic floor muscles can compensate for this stretching or tearing but if they become weak then the pelvic organs may not be held in their correct place and will bulge into the vagina. Pelvic organ prolapse is the term used to describe any bulge although it may be divided further into cystocele (bladder prolapse), rectocele (rectal prolapse) or uterine prolapse.

Female pelvic organ prolapse is a common occurrence. It won’t go away by itself but there is help available. An early prolapse may be unnoticeable but as it becomes larger you may notice symptoms such as:

A heavy or dragging sensation in the vagina
A sense of something “coming down” or a lump in the vagina
A bulge felt vaginally especially when showering
Loss of sensation with intercourse for either partner
Your bladder might not empty as it should or you may suffer recurrent urinary tract infections
Dragging or back pain especially towards the end of the day
Need to push inside the vagina to pass urine or stool

Causes of Prolapse

The main cause of prolapse is pregnancy and vaginal birth although other common causes include chronic coughing, heavy lifting and constipation. Prolapse may also run in the family. It is more likely to occur after menopause or if you are overweight, but it can happen to young women, particularly if they have recently had a baby.

Treatment

Like many things, prevention is often best. As prolapse can present with prolonged weakness of the pelvic floor muscles, all women should keep their pelvic floor muscles strong and do daily exercises throughout their life. If the pelvic floor muscles are already weak, they can be strengthened with the help of a pelvic floor physiotherapist.

The first step to treatment is to identify the type of prolapse and the symptoms that are bothering you. Dr Budden can assess the pelvic floor to determine where the problem lies but the symptoms you are suffering from and your current activities will guide the measures Dr Budden will recommended. Once the type of prolapse is identified and we have outlined your symptoms and goals for improvement, treatment can follow one or all of the following:

Conservative measures such as pelvic floor muscle training, changes in lifestyle and being aware of good bowel and bladder habits are always discussed. For some women this is all that is required to improve their symptoms. Dr Budden may also discuss the use of oestrogen cream to improve the health of the vaginal skin and pelvic floor muscles.

Vaginal pessary – There are a number of shapes and sizes of pessary. Dr Budden will discuss why a pessary may be beneficial to you before discussing the type that may be best for you. Over time you may need to change sizes or shapes of pessary if the prolapse continues to worsen.

Surgery – The aim of surgery is to repair torn or stretched supporting tissues. The surgery can be done vaginally or abdominally (as an open procedure or laparoscopic). The aim of the surgery is to make the vaginal wall stronger, however one in three women will have a recurrence of prolapse after surgery. Dr Budden will discuss the reasons why you may or may not be a good candidate for surgery, the risks of recurrence and what factors may help reduce your risk of recurrence. Some of the reasons why surgery may not be the best option for you include if you plan to become pregnant in the future, your age and general health, work or family commitments that require heavy lifting and the nature of the prolapse.