Pelvic organ prolapse

What is pelvic organ prolapse?

A pelvic organ prolapse is where an organ protrudes through and bulges an abnormal opening into the vagina. This can happen when the ligaments or muscles that usually hold the organs in place get weak. 

The main organs that can slip down include the bladder and the bowel. There are different names depending on what organs are involved. 

• Cystocele – where the bladder protrudes backwards into the vagina

• Rectocele – where the bowel protrudes into the vagina

• Uterine prolapse – where the uterus slips down into the vagina. 

• Vault prolapse – where the top of the vagina can protrude into the bottom part, which can happen to people after a hysterectomy.

What are the symptoms of pelvic organ prolapse?

Some people with pelvic organ prolapse don’t have any symptoms, but some people may experience:

• A bulge in the vagina

• Feeling something coming down in the vagina

• A heavy sensation or dragging in the pelvis

• Seeing or feel a lump in the vagina

• Discomfort during sex

• Problems peeing, like needing to go more or less often than normal, or leaking after coughing or sneezing

• Problems pooing, like needing to go more or less often or not being able to control when you go

Although they’re bothersome, pelvic organ prolapses are not life-threatening.

What causes pelvic organ prolapse?

Since the vagina is sandwiched between the bladder and bowel, it needs muscles, ligaments and connective tissue to keep all these organs in place and support them. Some people develop a weakness in this support structure, which can cause prolapse. Some common risk factors include:

• Pregnancy and childbirth

• Older age and menopause

• Being overweight

• Constipation

• Hysterectomy

• Heavy lifting

• Other health conditions that can weaken the connective tissue which supports your organs, such as joint hypermobility syndrome, Marfan syndrome and Ehlers-Danlos syndrome

How common is pelvic organ prolapse?

1 in 10 women over the age of 50 in the UK will experience a pelvic organ prolapse. But only a small number of patients will feel any discomfort, and so treatment is rarely needed.

How is pelvic organ prolapse diagnosed?

A GP will usually first ask you to use the toilet to make sure your bladder and bowels are empty. They will ask you to undress from the waist down and lay down on the examination bed, so they can have a feel of your tummy and pelvis, followed by a feel of the inside of your vagina for any lumps. The doctor may want to use a speculum, which holds the walls of the vagina open for a better look of the inside.

If you feel uncomfortable being alone in this situation, YyYou are welcome to bring someone for support or ask for a chaperone.

If there are any concerns with your bladder, the GP will refer you to the hospital for further tests to make sure everything is ok. You may require a urine test to check for infection or a bladder scan to see how your bladder is working.

How to treat pelvic organ prolapse?

In most cases there is no need for treatment as the prolapse does not tend to cause discomfort, although lifestyle changes can always help, such as:

• Losing weight

• Avoid heavy lifting

• Treating or preventing constipation

If the prolapse is affecting your daily life, there are several treatments that can be considered depending on your symptoms:

• Other lifestyle changes, like avoiding caffeine or using incontinence pads

• Pelvic floor exercises, also known as Kegel exercises, are done to strengthen the pelvic muscles that control when to pee and poo

• Medication to help with bladder control 

• Vaginal pessaries are devices that are fitted into the vagina and act as support to prevent prolapses

In some cases, surgery to support the pelvic organs might be an option. Although keyhole, or laparoscopic, surgery can be done laparoscopically to reduce complications, there is always a small risk of pain, bleeding or, damage to the bladder or bowel. It’s also possible for the prolapse to come back in the future

There are different surgeries that the gynaecologist may want to do depending on your prolapse. The most common types of surgery include:

• Pelvic floor repair – surgery done through the vagina to support the pelvic organs

• Vaginal hysterectomy – the removal of the uterus to help with uterine prolapses

• Sacrocolpopexy – placing a mesh to maintain the vaginal wall

• Sacrospinous fixation – securing the top of the vagina to a strong ligament in the pelvis

When should I talk to a doctor?

Go see your GP if you notice any of the symptoms of prolapse or if you feel a lump in or around your vagina. 

If you have bleeding, discharge from the vagina, pelvic pain or pain during sex, this may be something more serious that requires urgent attention, so please let us know as soon as possible.

How can Livi help?

A Livi healthcare professional can discuss your symptoms and advise the best course of action to treat your prolapse and relieve your symptoms. They will be able to discuss the likely cause and can refer you to a specialist if needed.