Prolapse

About prolapse

Pelvic organ prolapse, or simply “prolapse” occurs when tissues that support and hold the pelvic organs (uterus, bowel and bladder) in their normal positions become damaged and weakened.

As a result, one or more of these organs prolapse (or “drop”) into the vagina.  It is a bit like a hernia except that it occurs through the vagina.

What causes prolapse?

A number of factors can contribute towards weakening the pelvic floor muscles and causing prolapse.  These include:

  • Labour and childbirth

  • Obesity

  • Longstanding constipation

  • Chronic chest problems causing chronic coughing

  • Work or lifestyle that requires heavy lifting or straining

Advancing age, and especially the reduction of oestrogen after menopause, leads to further weakening.  Some women have a genetic predisposition towards prolapse.

A small amount of prolapse is normal in many women who have had a baby and if there are no significant symptoms it is not a cause for concern.

 What are the symptoms of prolapse?

  • A feeling of pressure or pain symptoms

  • A noticeable lump or protrusion

  • A dragging sensation

  • Bladder or bowel changes with urgency or incontinence

More information about Prolapse

What are the types of prolapse?

Prolapse can arise in the front wall of the vagina, back wall of the vagina or the top of the vagina (vaginal vault).  Often a prolapse involves a combination of these areas;

  1. An anterior wall prolapse (cystocele) arises when the bladder moves backward into your vagina, creating a bulge that can sometimes be felt on the inside of the vagina.

  2. A posterior wall prolapse (rectocele) arises when the lower part of your bowel (rectum) bulges through the back wall of the vagina.

  3. A uterine prolapse arises when your uterus and cervix drops downwards into your vagina.

  4. A prolapse of the vaginal vault can occur if you had previously had a hysterectomy and the top of the vagina (vault) collapses and drops into the vagina.

What are the treatment options?

The treatment options for pelvic organ prolapse depend on the severity of the condition and individual circumstances.  They can include:

  1. Conservative management:  this might involve lifestyle changes, such as weight management, avoiding heavy lifting and pelvic floor exercises to strengthen the muscles that support the pelvic organs.

  2. Pelvic floor physiotherapy:  a trained pelvic floor physiotherapist can guide you through exercise to strengthen and improve the function of the pelvic floor muscles.

  3. Pessaries:  these are devices that are inserted into the vagina to provide support for the prolapse organs.  See attached information pamphlet on pessaries: https://www.ugsa.com.au/content.cfm?page_id=1384734&current_category_code=22260

  4. Vaginal oestrogen can help reduce the dryness of the vaginal tissue and reduce the symptoms of prolapse.

  5. Surgery:  surgical options include repairing the front or back wall of the vagina or a vault suspension.  Hysterectomy might also be considered in some cases. https://www.ugsa.com.au/content.cfm?page_id=1425726&current_category_code=22260

How common is a prolapse?

Unfortunately prolapse is very common.  With the biggest cause of prolapse being prior pregnancy and child birth with 50% of women who have been pregnant will have some kind of prolapse.

For more information regarding prolapse, see Ranzcog pamphlet below: