Worried about prolapse? There’s no reason to suffer in silence. Read on to discover the signs, symptoms and treatment for this common problem.
Do you need to wear a pad when you exercise or find it hard to make it to the toilet on time? You may be at the onset of developing some form of pelvic organ prolapse (POP). And you could be making it worse by doing everyday things, such as lifting small children or going for a run. Don’t ignore the symptoms.
What is pelvic organ prolapse?
Pelvic organ prolapse starts with a weakening of the pelvic floor muscles, causing any one or more of the pelvic organs to shift out of position into the vaginal canal. There are five different types of pelvic organ prolapse:
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- Bladder (cystocele)
- Intestines (enterocele)
- Rectum (rectocele)
- Uterus (uterine)
- Vagina (vaginal vault)
The Association for Pelvic Organ Prolapse Support (APOPS) estimates that in the Western world, one in four women – of every age and demographic – suffers from some form of POP. And according to the Royal College of Obstetricians and Gynaecologists (RCOG), this figure increases to one in two, in women over 50.
Pelvic organ prolapse cause
The most common causes of pelvic organ prolapse include:
- Vaginal childbirth
This is the main cause of POP. Complicated labours, such as forceps deliveries or multiple childbirths, can cause immediate impact, although symptoms might not show up until many years later.
Due to the drop in oestrogen levels during the menopause, the pelvic floor muscle tissue stops working as effectively.
- Chronic constipation
Chronic constipation or straining with bowel movements can lead to increased pelvic floor pressure.
- Chronic coughing
If you suffer from a chronic cough, every time you cough your internal organs could be pushing down into your vaginal canal.
- Heavy lifting
This can be not just work-related lifting, but also the simple act of lifting children or heavy shopping bags.
- Pounding exercise
Pounding exercise includes high impact activities such as running and aerobics.
There is a genetics factor to take into account, too. And if you suffer from a neuromuscular disease, such as Multiple Sclerosis, there is a higher chance that you will also develop POP.
Women suffering from POP most likely have more than one of the above mentioned risk factors. But beware, it’s also possible for women who have never given birth to develop POP.
Pelvic organ prolapse symptoms
If you’re concerned about POP, there are sometimes signs you can look out for, although you may not realise it has happened.
‘You may not know you have a prolapse, as many women have no symptoms at all,’ explains Dr Lee. ‘Sometimes your doctor may discover the prolapse when they are examining you for a swab or a smear.’
However, Dr Lee says the following symptoms may be present:
- Problems passing urine: passing urine when you cough or sneeze; feeling you haven’t emptied your bladder properly; rushing to the toiletto have a pee; getting up at night frequently to pee; or recurrent urinary tract infections.
- A dragging sensation in the pelvis/lower abdomen: Some describe this as a pressure feeling – a sensation of fullness down below.
- The feeling of a lump moving downwards: perhaps when you strain to open your bowels.
- Low back pain or discomfort.
- Feeling or seeing a lump: sometimes it’s a bulge of tissue protruding from your vagina.
- Numbness, lack of sensation or discomfort during sex: Some women feel their vagina is too loose and has lost its tone.
- Problems opening your bowels: sometimes women report having to insert a finger in the vagina to help the stool to pass.
- Abnormal vaginal bleeding.
Pelvic organ prolapse treatment
Treatment for POP depends on the type of prolapse you have, as well as the severity of your symptoms.
‘If your prolapse is not causing any symptoms or is hardly troubling you, there is no need to do anything at all,’ says Dr Lee. ‘If, however, you are experiencing symptoms, you should discuss this with your doctor.’
Prolapse can be treated in several ways. Dr Lee explains that the choice of treatment will depend on:
- The type of prolapse you have.
- Your specific symptoms.
- The severity of your symptoms.
- Your age and general health.
Treatment options range from simply making changes to your lifestyle, right through to surgery.
Pelvic organ prolapse and lifestyle changes
There are a number of lifestyle change you can make which can improve your chances of making a full recovery.
‘It’s important to consider the prolapse in the context of your general health,’ says Dr Lee. ‘Prolapse can be made worse by being overweight, having a poor level of general fitness and muscle tone, and a poor diet with constipation. In addition, smoking is known to irritate the bladder and pelvic floor. A chronic smoker’s cough also makes symptoms worse.’
Prolapse can be made worse by being overweight, having a poor level of general fitness and muscle tone.
‘The first step is to address all these issues and see what improvements you can achieve by improving your lifestyle,’ she adds. ‘Lose weight, improve your fitness, improve your diet and try to stop smoking. Avoid stressing your pelvis by heavy lifting. This may be all that is required to improve your symptoms.’
The importance of pelvic floor exercises
Pelvic floor exercises are key – and are important for prevention, too!
‘You will be strongly advised to do pelvic floor exercises to strengthen your pelvis muscles,’ says Dr Lee. ‘After doing their exercise, three to 10 women out of 100 will not require surgery. These exercises may not reverse the prolapse, but they will help your muscle tone improve, reduce the severity of your symptoms and help stop the prolapse getting worse.’
Dr Lee says that you will usually be asked to try these exercises for 16 weeks before surgery is contemplated.
‘If you don’t know how it feels to exercise your pelvic floor, when you next have a pee, try stopping and starting your flow of urine,’ says Dr Lee. ‘This is what it feels like.
‘To do the exercises, contract your pelvic floor 15 to 20 times a day for a week, and then gradually increase the number of contractions. You should also try to squeeze and hold for several seconds before letting go. However, you should not be doing these exercises regularly when you’re passing urine, as it can lead to urine infections.
Dr Lee says you should notice an improvement within a few weeks, but don’t stop… keep doing them! These exercises are something women need to do for life.Pelvic organ prolapse vaginal pessaries
Vaginal pessaries can help with POP recovery. ‘Vaginal pessaries are devices that are inserted into the vagina, which then hold the vaginal walls in the correct position,’ says Dr Lee. ‘They come in different sizes and shapes, and are made of rubber (containing latex) or silicone (latex-free).
‘They are inserted by your gynaecologist, or sometimes by your GP. It’s usually quick and, although a little uncomfortable, is not painful,’ she adds. ‘Your doctor will need to assess the prolapse and your vagina, and then choose the right size and shape of device. Also, not every prolapse is suitable for a pessary.’
Vaginal pessaries are devices which hold the vaginal walls in the correct position.
Dr Lee advises that pessaries are changed every three to six months, and that women sometimes notice an increase in urine infections while using pessaries. ‘This is presumably because the pessary is resting against the urethra – the neck of the bladder,’ she says. ‘This may indicate the pessary is a little too large, so discuss this with your doctor.’
And if you have concerns about your love life, it is possible to have sex with the pessary in situ.
Pelvic organ prolapse surgery
There are several types of surgery to correct prolapse. ‘The exact operation will depend on what type of prolapse you have, how large it is, your age and physical fitness, and whether for any reason other surgery, such as a hysterectomy, needs to be performed at the same time,’ says Dr Lee. ‘Your gynaecologist will discuss this with you.’
Prolapse surgery is usually done under a general anaesthetic, meaning you will be asleep. ‘You should be given a full description and explanation of the procedure in advance and be able to ask any questions,’ says Dr Lee. ‘The consent process involves you being made aware of the risks of the procedure and the likely outcome if those risks were to take place. You will be asked to sign a consent form and you are entitled to keep a copy.’
Pelvic organ prolapse surgery options
Dr Lee explains that surgical options include:
✔️ Anterior/posterior vaginal wall prolapse
These operations are done through the vagina. They can be done using your own tissue as a simple repair, or by using a mesh insert, which adds strength and helps the repair to be longer-lasting.
✔️ Uterine prolapse
If the uterus is prolapsing, this can be lifted and stitched up inside you. This can sometimes be done via keyhole surgery (laparoscopic surgery) through your lower abdomen.
Sometimes you may need a hysterectomy (removal of the uterus). This can be done either through the vagina, through an incision in your lower abdomen, or sometimes using keyhole surgery.
✔️ Vaginal closure
This is called a colpocleisis. It’s done occasionally if you are elderly and in a poor medical condition.
✔️ Transvaginal tape (TVT)
This is a mesh tape inserted under the urethra, to help improve stress incontinence. This is frequently done at the same time as a vaginal prolapse repair.
‘Although prolapse surgery is frequently successful, around 25 in 100 women who have prolapse surgery will require further surgery in the future,’ says Dr Lee.
More about mesh repairs
While it sounds like a simple procedure, be warned that the use of mesh has come under scrutiny in recent years, following complications including infections, bleeding and mesh erosion.
‘There has been considerable controversy about the long-term effects of using mesh for prolapse repairs and to treat stress incontinence,’ says Dr Lee. ‘Mesh is essentially a piece of netting, made of polypropylene, which can be inserted at the time of surgery. In 2017, the National Institute for Health and Care Excellence (NICE) considered the available evidence and concluded mesh should no longer be used, apart from use for research purposes. However, in 2019 this guidance was updated to state that women should be informed of their options.’