Bladder > Bladder Problems > Prolapse

Prolapse

What is Prolapse?

Prolapse is a condition in which one or more of the pelvic organs comes down or bulges into or out of the vagina, often with the sensation of 'something coming down below'. The pelvic organs consist of the uterus, bowel and bladder. Pelvic organ prolapse occurs when the network of supporting tissues that holds these organs in their correct positions become weakened.

Symptoms include:

• A heavy dragging feeling in the vagina or lower back.
• Feeling of a lump in the vagina or outside the vagina.
• Urinary problems such as slow stream, a feeling of incomplete bladder emptying, frequency, urgency and stress urinary incontinence.
• Bowel problems such as difficulty moving the bowel or a feeling of not emptying properly.
• Discomfort during sexual intercourse.
• What causes pelvic organs to prolapse?
• Pelvic organs can start to prolapse due to damage of the ligaments and muscles which support the pelvic organs. Damage can arise from:
• Pregnancy and childbirth which are considered major factors.
• Menopause.
• Conditions that cause excessive pressure on the pelvic floor like obesity, persistent coughing, heavy lifting and chronic constipation.
• It may also occur as a result of other medical conditions that can damage the muscles, nerves and ligaments in the pelvis. In rare cases, an abdominal or pelvic mass or tumour can cause a prolapse or make a prolapse worse.

Where can a prolapse occur?

A prolapse may occur on the front wall of the vagina, back wall of the vagina, the uterus or top of the vagina.

Prolapse of the front wall of the vagina

This is the most common type of prolapse and involves the bladder and /or urethra bulging into the vagina.

Prolapse of the back wall of the vagina

This is when the lower part of the large bowel bulges into the back wall of the vagina and/or part of the small intestine bulges into the upper part of the back wall of the vagina.

Uterine prolapse

This occurs when the uterus (womb) drops or herniates into the vagina. This is the second most common form of prolapse.

Vaginal vault prolapse

Following a hysterectomy, the top of the vagina may collapse downwards, towards or out of the vagina.

How can pelvic organ prolapse be treated?

Treatment options can be categorised into non-surgical and surgical options.

Non-surgical options;

• Prolapse is rarely a life threatening condition and many women will choose not to have any treatment if they have no symptoms or discomfort.
• Pessaries are vaginal devices that come in various shapes and sizes. Pessaries help by providing mechanical support to the prolapsed organs which relieves the symptoms.
• Pelvic floor exercises strengthen the weakened pelvic floor muscles which will improve or prevent worsening of the prolapse. See below for more information.

Surgical options;

• A surgical repair may be offered to women with symptomatic prolapse. The type of treatment recommended will depend on a number of factors including age, previous surgical history, the severity of the prolapse and general health.
• There are two main options; reconstructive surgery and vaginal closure surgery. Approximately 75% of women who choose vaginal surgery and 90-95% who choose the abdominal approach will have a long term cure of their prolapse symptoms.
• The purpose of pelvic reconstructive surgery is to restore the pelvic organs to their natural position while retaining sexual function. There are many different ways to accomplish the surgery; vaginal approach, abdominal approach, laparoscopic and robotic.
• Vaginal closure surgery is performed only if the prolapse is severe and the woman is not sexually active, or if she is medically unfit for reconstructive surgery. During this procedure the surgeon will stich the vaginal walls together which will prevent the prolapse from re-occurring.

Seeking help

If you are concerned about your problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.

You can also call our helpline on 0845 345 0165 (24 hour answerphone) for medical advice, or visit our Continence Clinic Database facility in the Specialist Services section to find out where your nearest clinic is or call our general enquiries line on 01536 533255 for details.

If you have a prolapse your GP will refer you to see a gynaecologist. The gynaecologist will examine you internally by gently feeling inside the vagina and will often insert an instrument to help do this (speculum). The examination will help to find out how severe a prolapse is and which part of the vagina or womb is affected. They may ask you to cough or bear down, to see whether this increases the prolapse or causes leakage of urine.

Please use the link boxes below to find out about treatment and product options that may be suitable. If you have other urinary symptoms please visit our main Bladder Problems page to use the drop down menus to find information on symptoms and conditions associated with the bladder.