Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the muscles and tissues supporting the pelvic organs become weakened, allowing the bladder, uterus or bowel to move downwards and press into or towards the vagina.

The type of prolapse depends on which organ or area of support is affected. Prolapse can involve the bladder (cystocele), rectum (rectocele), uterus, or the top of the vagina following a hysterectomy.

Symptoms vary depending on the type and severity of prolapse. Some people may have no symptoms, while others may experience:

• A feeling of pressure, heaviness or fullness in the pelvis
• A bulge or lump in or around the vagina
• Difficulty emptying the bladder
• Urinary symptoms
• Difficulty emptying the bowel
• Discomfort during sexual activity

If you are experiencing these symptoms, a pelvic floor or urology assessment can help determine whether prolapse or another condition is responsible.

Pelvic organ prolapse occurs when the structures supporting the pelvic organs become weakened or stretched. Factors that can contribute to pelvic floor weakness include:

• Pregnancy and childbirth
• Increasing age
• Menopause and changes associated with ageing
• Chronic constipation and straining
• Persistent coughing
• Conditions that increase pressure on the pelvic floor
• Previous pelvic surgery

A specialist will discuss your symptoms and medical history and may perform a pelvic examination to assess the pelvic organs and supporting tissues.

The assessment may also consider bladder and bowel function, as pelvic floor problems can affect how these systems work. Further investigations may be recommended depending on your symptoms and individual circumstances.

Treatment depends on the type and severity of prolapse, your symptoms and how much they affect your daily life. Some people with prolapse do not require treatment if they have no bothersome symptoms.

Where treatment is appropriate, options may include non-surgical management or surgery.

Non-surgical approaches may include,

Pelvic floor exercises and physiotherapy

• Pelvic floor muscle training can help strengthen the muscles that support the pelvic organs. A pelvic health physiotherapist can assess your pelvic floor and provide an individual exercise programme.

Pessary

• A pessary is a removable device placed inside the vagina to support the pelvic organs.
• Different types and sizes are available, and a healthcare professional can assess whether a pessary is suitable and assist with fitting.

Lifestyle measures

• Depending on your symptoms, your healthcare professional may recommend measures such as avoiding constipation and reducing activities that place excessive strain on the pelvic floor.

Surgical treatment

• Surgery may be considered when prolapse symptoms are significant or when non-surgical treatment has not provided sufficient relief.
• Surgical treatment aims to repair or reinforce the structures supporting the pelvic organs. Depending on the type of prolapse and individual circumstances, surgery may be performed using different approaches, including minimally invasive or robotic-assisted techniques.

Your specialist will explain the available procedures, including their potential benefits and risks, and recommend an approach based on your individual condition and preferences.