Your pelvic organs include your bladder, uterus (womb) and rectum (back passage). These organs are held in place by tissues called 'fascia' and 'ligaments'. These tissues help to join your pelvic organs to the bony side walls of the pelvis and hold them inside your pelvis.
Your pelvic floor muscles also hold up your pelvic organs from below. If the fascia or ligaments are torn or stretched for any reason, and if your pelvic floor muscles are weak, then your pelvic organs might not be held in their right place and they may bulge or sag down into the vagina.This is known as a pelvic organ prolapse (POP).
There are a few signs that you may have a prolapse. These signs depend on the type of prolapse and how much pelvic organ support has been lost. Early on, you may not know you have a prolapse as there will be no symptoms, but your doctor or nurse might be able to see your prolapse when you have your routine Pap smear test.
When a prolapse is further down, you may notice things such as:
These signs can be worse at the end of the day and may feel better after lying down. If the prolapse bulges right outside your body, you may feel sore and bleed as the prolapse rubs on your underwear.
Childbirth is the main cause of a prolapse. On the way down the vagina, the baby can stretch and tear the supporting tissues and pelvic floor muscles. The more vaginal births you have, the more likely you are to have a prolapse.
Other things that press down on the pelvic organs and the pelvic floor muscles that can lead to prolapse are:
Pelvic organs may bulge through the front wall of the vagina (called a cystocele), through the back vaginal wall (called a rectocele or an enterocele) or the uterus may drop down into the vagina (uterine prolapse). More than one organ may bulge into the vagina.
Prolapse tends to run in families. It is more likely after menopause or if you are overweight. But it can happen in young women right after having a baby.
About half of all women who have had a child have some level of prolapse, but only one in five women need to seek medical help.
It is much better to prevent prolapse than try to fix it! If any women in your close family have had a prolapse, you are more at risk.
As prolapse is due to weak pelvic tissues and pelvic floor muscles, all women should keep their pelvic floor muscles strong - no matter what their age.
Pelvic floor muscles, just like any other muscles, can be made stronger with the right exercises. It is important to have your pelvic floor muscle training checked by an expert such as a pelvic floor physiotherapist or a continence nurse advisor.
If you have been told you have a prolapse, these experts are the best people to help plan a pelvic floor muscle training program to suit your needs.
Prolapse can be dealt with simply or with surgery depending on the level of prolapse.
Prolapse can often be treated without surgery, chiefly in the early stages, and when the prolapse is mild. The simple approach can mean:
Surgery can be done to repair the torn or stretched fascia and ligaments. Surgery can be done through the vagina or the tummy. Sometimes special mesh is used to strengthen it where it is weak or torn. As the body heals, the mesh helps form stronger tissues to give more support where it is needed.
To prevent prolapse coming back again, you should make sure you:
Prolapse is common. It won't go away if you ignore it, and help is available. For best results seek help from your doctor, physiotherapist or continence nurse advisor who will advise you on the best way to deal with prolapse.
If you have any questions about prolapse or about bladder and bowel control, you can contact the National Continence Helpline on freecall 1800 33 00 66.