ABOUT PROLAPSE

What is a pelvic organ prolapse?

Your pelvic organs (bladder, uterus and bowel) are held in place by tissues called 'fascia' and 'ligaments'. These supporting 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 supporting tissues are torn or stretched, 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.

Prolapse diagram

Types of prolapse

Pelvic organs may bulge into the front wall of the vagina (cystocele), through the back vaginal wall (rectocele or enterocele) or the uterus may drop down into the vagina (uterine prolapse). More than one of the pelvic organs may bulge into the vagina.

FEATURED VIDEO

Let’s talk about prolapse

Nurse Continence Specialist Christine Murray, answers common questions about prolapse, and where to go for help and further information.

SIGNS

Signs will depend on the type and level of prolapse

Early on, you may not notice the signs of prolapse, but your doctor or nurse might be able to see it when you have your routine pap smear test.

When a prolapse is further down, you may notice things such as:

  • a heavy sensation or dragging in the vagina
  • something ‘coming down' or a lump in the vagina
  • a lump bulging out of your vagina that you can see or feel
  • sexual problems (pain or less sensation)
  • your bladder not emptying as it should
  • weak urine stream
  • recurring urinary tract infections
  • difficulty emptying your bowel.

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.

CAUSES

Childbirth is the main cause of a prolapse. On the way through 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 causes of prolapse include:

  • persistent coughing (such as smoker's cough, bronchitis or asthma)
  • lifting heavy weights
  • constipation - long-term, persistent straining to empty the bowel can cause prolapse.

RISK FACTORS

Some women have a higher risk of prolapse

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.
  • Prolapse can also happen in women who haven’t had a baby, mainly if they cough, strain on the toilet or lift heavy loads.
  • Even after surgery to repair prolapse, one in three women will prolapse again.
  • Prolapse can also happen in women who have had their womb removed (hysterectomy). In a case like this, the top of the vagina (the vault) can prolapse.

PREVENTION

Ways to help prevent prolapse

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 technique checked by an expert such as a Women's, Men's and Pelvic Health Physiotherapist or a Nurse Continence Specialist

Learn more about the pelvic floor in women.

TREATMENT

Non-surgical options

Prolapse can often be treated without surgery, especially in the early stages and when the prolapse is mild. This approach can mean:

  • pelvic floor muscle training with the advice of a Women's, Men's and Pelvic Health Physiotherapist or Nurse Continence Specialist
  • learning what caused your prolapse, and making necessary lifestyle changes, such as improving your diet, fluid intake, exercising and losing weight
  • being aware of good bowel and bladder habits to avoid straining on the toilet
  • having a pessary (a plastic or rubber device that fits into your vagina) carefully measured and placed into the vagina to provide inside support for your pelvic organs.

Surgical approach

Surgery can be done to repair torn or stretched support tissues and ligaments. There are different surgical options including:

  • abdominal approach
  • vaginal approach
  • laparoscopic (keyhole)
  • robotic

The surgery makes the vaginal wall stronger and helps the tissues support the pelvic organs. A surgeon can advise the best option. 

After surgery, you should make sure you:

  • have expert training to make sure your pelvic floor muscles work to support your pelvic organs
  • don't strain when using your bowels
  • keep your weight within the right range for your height and age
  • learn safe ways of lifting, including sharing the lifting of heavy loads
  • see your doctor if you have a cough that won't go away, and
  • see your doctor if simple things don't seem to make it better.

SEEK HELP

In many cases incontinence can be prevented, better managed and even cured. Talk to your doctor or contact the National Continence Helpline on 1800 33 00 66.

The National Continence Helpline is staffed by Nurse Continence Specialists who offer free and confidential information, advice and support.  They also provide a wide range of continence-related resources and referrals to local services.

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Last Updated: Mon 19, Oct 2020
Last Reviewed: Wed 01, Apr 2020