ABOUT PROLAPSE
What does pelvic organ prolapse mean?
The pelvic organs, which include the bladder, vagina, uterus and bowel, are held in place by the pelvic floor muscles and supporting tissues such as ‘fascia' and 'ligaments'. These help to join the pelvic organs to the bony side walls of the pelvis and keep them in place.
Your pelvic floor muscles also work to support the pelvic organs from underneath. If the supporting tissues are torn or stretched, and you’re the pelvic floor muscles are weak, then the pelvic organs may not be held in their right place.
Pelvic organ prolapse (POP), occurs when one of the pelvic organs sags and may bulge or protrude into the vagina.
Are there different types of prolapse?
There are different types of prolapse, and it is important to have any prolapse properly assessed.
Pelvic organs may bulge:
- into the front wall of the vagina (cystocele)
- through the back vaginal wall (rectocele or enterocele)
More than one of the pelvic organs may bulge into the vagina.
FEATURED VIDEO
Let’s talk about prolapse
Nurse Continence Specialist Christine Murray answers common questions about prolapse, and where to go for help and further information.
What are the SIGNS and Symptoms of Prolapse?
Signs and symptoms will depend on the type and level of prolapse
Early on, you may not notice the signs of prolapse, but your doctor or nurse may be able to see it when you have your routine pap smear test.
When a prolapse is further down, you may notice things such as:
- a lump bulging out of your vagina that you can see or feel
- a heavy sensation or dragging in the vagina
- something ‘coming down' or a lump in the vagina
- difficulty emptying your bladder or bowel
- lower back pain
- sexual problems (pain or less sensation)
- weak urine stream
- recurring urinary tract infections
These signs and symptoms can be worse at the end of the day and may improve after lying down. If the prolapse bulges right outside your body, you may feel sore and bleed as the prolapse rubs on your underwear.
What are the CAUSES of prolapse?
Childbirth is the main cause of a prolapse. On the way through the vagina, the baby can stretch and tear the supporting tissues and pelvic floor muscles. The more vaginal births you have, the more likely you are to have a prolapse.
Other causes of prolapse can include:
- persistent coughing with a chronic lung condition, such as smoker's cough, bronchitis or asthma
- lifting very heavy weights
- chronic constipation with persistent straining to empty the bowel
How common is prolapse?
Some women have a higher risk of prolapse
Prolapse can run in families. It is more likely after menopause, or if you are overweight, however it can occur in young women soon after having a baby.
- About half of all women who have had a child have some level of prolapse, but only one in five women need to seek medical help
- Prolapse can also happen in women who haven’t had a baby, mainly if they have a chronic cough, strain on the toilet or lift very heavy loads
- Even after surgery to repair prolapse, one in three women will prolapse again
- Prolapse can also happen in women who have had their womb removed (hysterectomy). In a case like this, the top of the vagina (the vault) can prolapse
What can be done to prevent prolapse?
Ways to help prevent prolapse
As prolapse is due to weak pelvic tissues and pelvic floor muscles, all women need to keep their pelvic floor muscles strong - no matter what their age.
Pelvic floor muscles, just like any other muscles, can be strengthened with the correct exercises. It is important to have your pelvic floor muscle training technique checked by an expert such as a Pelvic Floor Health Physiotherapist or a Nurse Continence Specialist.
Learn more about the pelvic floor in women.
What treatment options are available for prolapse?
Non-surgical options
Prolapse can often be treated without surgery, especially in the early stages and when the prolapse is mild. This approach can include:
- pelvic floor muscle training with the advice of a Women's, Men's and Pelvic Health Physiotherapist or Nurse Continence Specialist
- understanding what caused your prolapse, and making necessary lifestyle changes, such as improving your diet, fluid intake, exercising and losing weight
- being aware of good bowel and bladder habits to avoid straining on the toilet
- having a pessary (a silicone device that fits into your vagina) carefully measured and placed into the vagina to provide internal support for your pelvic organs
Surgical approach
Surgery can repair torn or stretched support tissues such as ligaments and vaginal wall connective tissue, to help support the pelvic organs. There are different surgical options including:
- abdominal approach
- vaginal approach
- laparoscopic (keyhole)
- robotic
The surgery strengthens the vaginal wall and helps the vaginal wall connective tissues better support the pelvic organs. A surgeon can advise the best option.
After surgery, you should make sure you:
- have expert training to ensure your pelvic floor muscles work to support your pelvic organs
- avoid straining when using your bowels
- keep your weight within the right range for your height and age
- learn safe ways of lifting, including sharing the lifting of heavy loads
- see your doctor if you have a cough that won't go away, and
- see your doctor if these measures don't lead to improvement
Where can i find out more or seek help?
For more information, talk to your doctor or gynaecologist/urogynaecologist. You can also contact the National Continence Helpline on1800 33 00 66.
The National Continence Helpline is staffed byNurse Continence Specialists who offer free and confidential information, advice and support. They also provide a wide range of continence-related resources and referrals to local services.