Overview

Pelvic organ prolapse is when 1 or more of the organs in the pelvis slip down from their normal position and bulge into the vagina.

It can be the womb (uterus), bowel, bladder or top of the vagina.

A prolapse is not life threatening, but it can cause pain and discomfort.

Symptoms can usually be improved with pelvic floor exercises and lifestyle changes, but sometimes medical treatment is needed.

Symptoms of pelvic organ prolapse

Pelvic organ prolapse symptoms include:

  • a feeling of heaviness around your lower tummy and genitals
  • a dragging discomfort inside your vagina
  • feeling like there's something coming down into your vagina – it may feel like sitting on a small ball
  • feeling or seeing a bulge or lump in or coming out of your vagina
  • discomfort or numbness during sex
  • problems peeing – such as feeling like your bladder is not emptying fully, needing to go to the toilet more often, or leaking a small amount of pee when you cough, sneeze or exercise (stress incontinence)

Sometimes pelvic organ prolapse has no symptoms and is found during an internal examination carried out for another reason, such as cervical screening.

When to see a GP

See a GP if you have any of the symptoms of a prolapse, or if you notice a lump in or around your vagina.

What happens at your appointment

Your doctor will ask if they can do an internal pelvic examination.

For this you'll need to undress from the waist down and lie back on the examination bed.

Your doctor will then feel for any lumps in your pelvic area and inside your vagina.

They may gently put an instrument called a speculum into your vagina to hold the walls of it open so they can see if there's a prolapse.

Sometimes they'll ask you to lie on your left-hand side and examine you in that position to get a better view of the prolapse.

You can ask for this examination to be done by a female doctor and, if you like, bring someone you trust along with you for support.

Further tests

If you have problems with your bladder, a GP may refer you to hospital for further tests.

These may include:

  • a urine test to look for an infection
  • inserting a small tube into your bladder to look for any problems

Treatment for pelvic organ prolapse

If you do not have any symptoms, or the prolapse is mild and not bothering you, you may not need medical treatment.

But making some lifestyle changes will probably still help.

These include:

  • losing weight if you're overweight
  • avoiding heavy lifting
  • preventing or treating constipation

If the prolapse is more severe or your symptoms are affecting your daily life, there are several further treatment options to consider.

These include:

  • pelvic floor exercises
  • hormone treatment
  • vaginal pessaries
  • surgery

The recommended treatment will depend on the type and severity of the prolapse, your symptoms and your overall health.

You and your doctor will decide together what's the best option for you.

Causes of pelvic organ prolapse

Pelvic organ prolapse happens when the group of muscles and tissues that normally support the pelvic organs, called the pelvic floor, becomes weakened and cannot hold the organs in place firmly.

A number of things can weaken your pelvic floor and increase your chance of developing pelvic organ prolapse.

These include:

  • pregnancy and childbirth – especially if you had a long, difficult birth, or if you gave birth to a large baby or multiple babies
  • getting older and going through the menopause
  • being overweight
  • having long-term constipation or a long-term health condition that causes you to cough and strain
  • having a hysterectomy
  • a job that requires a lot of heavy lifting

Some health conditions can also make a prolapse more likely, including:

Types of prolapse

The 4 main types of prolapse are:

  • the bladder bulging into the front wall of the vagina (anterior prolapse)
  • the womb bulging or hanging down into the vagina (uterine prolapse)
  • the top of the vagina sagging down – this happens to some women after they have had surgery to remove their womb
  • the bowel bulging forward into the back wall of the vagina (posterior wall prolapse)

It's possible to have more than 1 of these at the same time.

Pelvic organ prolapse will usually be classified on a scale of 1 to 4 to show how severe it is, with 4 being a severe prolapse.

Treatment

There are several treatment options available for pelvic organ prolapse.

The most suitable for you will depend on:

  • the severity of your symptoms
  • the severity of the prolapse
  • your age and health
  • whether you're planning to have children in the future

You may not need any treatment if the prolapse is mild to moderate and not causing any pain or discomfort.

Treatment options include:

  • lifestyle changes
  • pelvic floor exercises
  • hormone treatment
  • vaginal pessaries
  • surgery

Your doctor should offer you the full range of treatments and explain the possible benefits and risks of each option. This will help you choose the right one for you.

Lifestyle changes

If you do not have any symptoms or the prolapse is mild, making some lifestyle changes can ease your symptoms and stop the prolapse getting worse.

They can also help reduce your risk of getting a prolapse in the first place.

They include:

  • losing weight if you're overweight
  • eating a high-fibre diet to avoid constipation
  • avoiding lifting heavy objects

Pelvic floor exercises

Doing pelvic floor exercises will strengthen your pelvic floor muscles and may well relieve your symptoms.

A GP or specialist may recommend a programme of supervised pelvic floor muscle training for at least 16 weeks before you move on to other treatments or surgery.

You'll be shown how to do the exercises. If they help, you may be asked to continue with them.

Hormone (oestrogen) treatment

If you have a mild prolapse and have been through the menopause, your doctor may recommend treatment with oestrogen to ease some of your symptoms, such as vaginal dryness or discomfort during sex.

Oestrogen is available as:

  • a cream you apply to your vagina
  • a tablet you insert into your vagina
  • an oestrogen-releasing vaginal ring

Vaginal pessaries

A device made of rubber (latex) or silicone is inserted into the vagina and left in place to support the vaginal walls and pelvic organs.

Vaginal pessaries allow you to get pregnant in the future. They can be used to ease the symptoms of moderate or severe prolapses and are a good option if you cannot or would prefer not to have surgery.

Vaginal pessaries come in different shapes and sizes depending on your need. The most common is called a ring pessary.

You may need to try a few different types and sizes to find the one that works best for you.

A gynaecologist or a specialist nurse usually fits a pessary. It needs to be removed, cleaned and replaced regularly.

Side effects of vaginal pessaries

Vaginal pessaries can occasionally cause:

  • unpleasant smelling vaginal discharge, which could be a sign of bacterial infection in the vagina (bacterial vaginosis)
  • some irritation and sores inside your vagina, and possibly bleeding
  • stress incontinence, where you pass a small amount of urine when you cough, sneeze or exercise
  • a urinary tract infection
  • interference with sex (but most women can have sex without any problems)

These side effects can usually be treated.

Surgery

If non-surgical options have not worked or the prolapse is more severe, surgery may be an option.

There are several different surgical treatments for pelvic organ prolapse.

They include:

  • surgical repair
  • vaginal mesh surgery
  • hysterectomy
  • closing the vagina

Your doctor will discuss the benefits and risks of different treatments, and you'll decide together which is best for you.

Surgical repair

There are several different types of surgery that involve lifting and supporting the pelvic organs.

This could be by stitching them into place or supporting the existing tissues to make them stronger.

Surgical repairs are usually done by making cuts in the wall of the vagina under general anaesthetic.

This means you'll be asleep during the operation and will not feel any pain.

You may need 6 to 12 weeks off work to recover, depending on the type of surgery you have.

If you'd like to have children in the future, your doctors may suggest delaying surgery because pregnancy can cause the prolapse to happen again.

Vaginal mesh surgery

At the moment, it's not possible to have vaginal mesh surgery for pelvic organ prolapse on the NHS unless there's no alternative and the procedure cannot be delayed, and after detailed discussion between you and a doctor.

Vaginal mesh surgery is where a piece of synthetic mesh, a plastic product that looks like a net, is inserted to hold the pelvic organs in place.

The mesh stays in your body permanently.

You'll be asleep during the operation and will usually need to stay in hospital for 1 to 3 days afterwards.

A few women have had serious complications after mesh surgery. Some, but not all, of these complications can also happen after other types of surgery.

The complications include:

  • long-lasting pain
  • permanent nerve damage
  • incontinence
  • constipation
  • sexual problems
  • mesh exposure through vaginal tissues and occasionally injury to nearby organs, such as the bladder or bowel

If you're concerned about vaginal mesh

If you have previously had vaginal mesh inserted and think you're having complications, speak to a GP or your surgeon.

If you're not having any complications, there's no need to do anything.

Many women have had these types of surgery without developing any problems afterwards.

You can report a problem with a medicine or medical device on GOV.UK.

Find out more about the rules for the use of vaginal mesh on GOV.UK

Hysterectomy

For women with a prolapsed womb who have been through the menopause or do not wish to have any more children, a doctor may recommend surgery to remove the womb (hysterectomy).

It can help to relieve pressure on the walls of the vagina and reduce the chance of a prolapse returning.

You cannot get pregnant after having a hysterectomy, and sometimes it may cause you to go through the menopause early.

You may need 6 to 12 weeks off work to recover.

Closing the vagina

Occasionally, an operation that closes part or all the vagina may be an option.

This treatment is only offered to women who have advanced prolapse, when other treatments have not worked and they're sure they do not plan to have sexual intercourse again in the future.

This operation can be a good option for frail women who would not be able to have more complex surgery.

Side effects of surgery

Your doctor should have an in-depth discussion with you about the risks and benefits of the 4 different types of surgery, including mesh surgery, before you decide together whether one of them could be an option.

Doctors must also keep detailed records about the type of surgery they do, including any complications you get after you have had your surgery.

You should be given a copy of this record.

Possible side effects of all 4 types of surgery, including mesh surgery, include:

  • risks associated with anaesthesia
  • bleeding, which may require a blood transfusion
  • damage to the surrounding organs, such as your bladder or bowel
  • an infection – you may be given antibiotics to take during and after surgery to reduce the risk
  • changes to your sex life, such as discomfort during intercourse – but this should improve over time
  • vaginal discharge and bleeding
  • experiencing more prolapse symptoms, which may require further surgery
  • a blood clot (DVT) forming in 1 of your veins, such as in your leg – you may be given medicine to help reduce this risk after surgery

If you have any of the following symptoms after your surgery, let your surgeon or a GP know as soon as possible:

  • a high temperature
  • severe pain low in your tummy
  • heavy vaginal bleeding
  • a stinging or burning sensation when you pee
  • abnormal vaginal discharge – this may be an infection

You should be offered a check-up 6 months after surgery that includes a vaginal examination.

More information to help you choose which type of prolapse surgery

There are several useful guides that you can read to help you decide, together with your doctor, which type of surgery would be right for you:

NICE guidance: management of urinary incontinence and pelvic organ prolapse in women – patient decision aids and user guides

Recovering from surgery

You'll probably need to stay in hospital overnight or for a few days following prolapse surgery.

You may have a drip in your arm to provide fluids, and a thin plastic tube (urinary catheter) to drain pee from your bladder.

Some gauze may be placed inside your vagina to act as a bandage for the first 24 hours, which may be slightly uncomfortable.

For the first few days or weeks after your operation, you may have some vaginal bleeding similar to a period, as well as some vaginal discharge.

This may last 3 or 4 weeks. During this time, use sanitary towels rather than tampons.

Your stitches will usually dissolve on their own after a few weeks.

Try to move around as soon as possible, but with good rests every few hours.

You should be able to have a shower and bathe as normal once you have left hospital, but you may need to avoid swimming for a few weeks.

It's best to avoid having sex for around 4 to 6 weeks, until you have healed completely.

Your healthcare team will advise about when you can return to work.

Find out more about having an recovering from an operation.



The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 19/01/2022 15:02:19