What is pelvic organ prolapse?

The organs within a woman’s pelvis (uterus, bladder and rectum) are normally held in place by ligaments and muscles known as the pelvic floor. If these support structures are weakened by overstretching, the pelvic organs can bulge (prolapse) from their natural position into the vagina. When this happens it is known as pelvic organ prolapse. Sometimes a prolapse may be large enough to protrude outside the vagina.

Prolapse is very common especially in older women. Half of women over 50 will have some symptoms of pelvic organ prolapse and by the age of 80 more than one in ten will have had surgery for prolapse.

Mild prolapse often causes no symptoms and treatment is not always necessary. Prolapse can affect quality of life by causing symptoms such as discomfort or a feeling of heaviness. It can cause bladder and bowel problems, and sexual activity may also be affected.

Why does pelvic organ prolapse happen?

Pregnancy and giving birth are the most common causes of weakening of the pelvic floor, particularly if your baby was large, you had an assisted birth (forceps/ventouse) or your labour was prolonged. The more births a woman has, the more likely she is to develop a prolapse in later life; however, you can still get a prolapse even if you haven’t given birth. Menopause, overweight, Constipation, persistent coughing or prolonged heavy lifting can cause a strain to the pelvic floor and can cause pelvic organ prolapse. It is possible to have a natural tendency to develop prolapse.

What are the different types of prolapse?

There are different types of prolapse depending on which organ is bulging into the vagina. It is common to have more than one type of prolapse at the same time.

The most common types of prolapse are:

  • Anterior wall prolapse (cystocele): when the bladder bulges into the front wall of the vagina.
  • Posterior wall prolapse (rectocele): when the rectum bulges into the back wall of the vagina.
  • Uterine prolapse: when the uterus hangs down into the vagina. Eventually the uterus may protrude outside the body. This is called a procidentia or third-degree prolapse.
  • Vault prolapse: after a hysterectomy has been performed, the top (or vault) of the vagina may bulge down. This is called a vault prolapse.

What are the symptoms of pelvic organ prolapse?

The most common symptom is the sensation of a lump ‘coming down’. You may also have had backache, heaviness or a dragging discomfort inside your vagina. You may be able to feel or see a lump or bulge. If your bladder has prolapsed into the vagina, you may experience the need to pass urine more frequently, have difficulty in passing urine or a sensation that your bladder is not emptying properly. Bladder prolapse can cause urine leakage on coughing, laughing or lifting heavy objects and have frequent urinary tract infections (cystitis).

If your bowel is affected, you may experience low back pain, constipation or incomplete bowel emptying. You may need to push back the prolapse to allow stools to pass.

Sex may be uncomfortable and you may also experience a lack of sensation during intercourse.