Condition: Pelvic Organ Prolapse

Pelvic organ prolapse is when one or more organs in the pelvis (the bladder, uterus, vagina, bowel and rectum) move down from their natural position. This causes the organs to bulge into the vagina, and in some cases, a prolapse may be large enough to protrude outside the vagina.

1 in 10 women over the age of 50 years is affected by pelvic organ prolapse. A prolapse is not life-threatening, but it can  affect quality of life of wen by causing pain, urinary and/or bowel symptoms such as incontinence or difficulties in passing urine or emptying your bowel, sexual dysfunctions and discomfort.

Pelvic organ prolapse happens when the ligaments and muscles in the pelvic floor become weakened and overstretched so can no longer hold the organs in place.

A number of factors can weaken the pelvic floor, increasing the risk of prolapse. These include:

• Pregnancy and vaginal childbirth
• Ageing and going through menopause
• Being overweight
• Long-term constipation
• A persistent cough
• Having a hysterectomy
• Regular heavy lifting

Certain health conditions including joint hypermobility syndrome, Marfan syndrome and Ehlers-Danlos syndrome can also increase the risk of having pelvic organ prolapse.

The symptoms of pelvic organ prolapse vary depending on the severity, but often include:

• A feeling of heaviness in the lower tummy and genitals
• A dragging sensation inside the vagina
• Backache
• Feeling or seeing a bulge coming out of the vagina
• Discomfort or lack of sensation during sex
• Passing urine more frequently and urgently or feeling that the bladder isn’t emptying fully
• Leaking urine when coughing, sneezing, exercising or lifting heavy objects
• Constipation or incomplete bowel emptying

Pelvic organ prolapse is diagnosed through an internal pelvic examination. In cases where there are no symptoms, pelvic organ prolapse is often discovered during a routine internal examination such as a cervical smear.

Symptoms can often be improved with pelvic floor exercises and lifestyle changes such as:

• Losing excess weight
• Stopping smoking
• Avoiding heavy lifting
• Preventing or treating constipation and coughs

In some cases, further medical treatment is also needed. The most suitable treatment depends on the type of prolapse and the severity but may be offered in the form of:

• Physiotherapy
• Vaginal pessaries – a latex or silicone device is inserted into the vagina to support the vaginal walls and pelvic organs
• Surgery – surgery tends to be offered in more severe cases of prolapse. Surgical treatments include surgical repair of the prolapsed organ, uterine suspension and/or hysterectomy