What is pelvic organ prolapse and how common is it?
Monday 21 January 2019
Pelvic organ prolapse, also known as pelvic floor prolapse, is much more common than you might think; you probably know someone who has it.
According to the Continence Foundation of Australia, over half of all women who have had a child have some level of prolapse.
Prolapse can have a substantial effect on a woman’s quality of life and up to one in five women who have a prolapse will need to seek medical help. We spoke with Queensland Acting Chief Allied Health Officer Liza-Jane McBride about what pelvic organ prolapse is, how it happens and how it’s treated.
What is a pelvic organ prolapse?
“The pelvic organs—bladder, uterus, large intestine and rectum—are held in place in the pelvis by fascia and ligaments. The pelvic floor muscles are a ‘sling’ of muscles that support these organs from beneath,” said Ms McBride.
“Without proper support—say from weak, torn or damaged fascia, ligaments or muscles—pelvic organs can bulge down into the vagina, or rectum, and that’s a prolapse.
“The prolapse can occur at the front wall of the vagina, which may give you bladder symptoms, the back wall of the vagina, which can have bowel symptoms, or you can have a uterine prolapse, where the uterus prolapses downwards into the vagina.”
Signs and symptoms of pelvic organ prolapse
Prolapses will affect different women in different ways, depending on the cause of their prolapse and their body. The Continence Foundation of Australia says signs and symptoms of prolapse depend on where it is occurring and how much support has been lost, and can include:
- a heavy sensation or dragging in your vagina
- something ‘coming down' or a lump in your vagina
- a lump bulging out of your vagina, which you see or feel when you are in the shower or having a bath
- sexual problems of pain or less sensation
- a bladder that doesn’t empty as it should, or a weak urine stream
- reoccurring urinary tract infections
- difficulty emptying your bowel.
Risk factors for prolapse
Risk factors for prolapse include vaginal birth, forceps delivery, high infant birth weight, age, obesity, previous hysterectomy, family history, heavy lifting, constipation, connective tissue disorders, menopause, and others.
Anything that puts pressure on the pelvic floor can result in prolapse—heavy lifting, strenuous exercise, excessive coughing—even in women that have not given birth.
How are pelvic organ prolapses diagnosed?
If you think you might be experiencing a pelvic organ prolapse, book in to see your GP, or if you’ve recently given birth, you might talk to your midwife or obstetrician. They can refer you to a gynaecologist, which is a doctor who specialises in women’s reproductive system health.
Gynaecologists use a grading system to measure prolapse degree called the POP-Q system.
- Stage 1: The wall/organ protrudes a little way into the vagina
- Stage 2: The wall/organ protrudes close to the vaginal opening
- Stage 3: The wall/organ protrudes out of the vagina
To find out if you have a prolapse and how it is affecting your body, your gynaecologist might order some tests. Tests that may be conducted include pelvic ultrasound, tests of bladder function, bladder ultrasound, and urine tests.
How are pelvic floor prolapses managed and treated?
The good news is that once diagnosed, a pelvic organ prolapse and its symptoms can be managed.
Management and treatment can include:
- physiotherapy and pelvic floor muscle training (see: How to find and exercise your pelvic floor muscles)
- lifestyle changes, such as weight loss, improved diet, fluid intake and exercise, and learning good bowel and bladder habits
- pessaries – a plastic or rubber device that fits into the vagina) can be fitted to provide internal support
- surgery to repair stretched or torn tissue and ligaments
Where to get help for pelvic organ prolapse
If you think you have a prolapse, don’t be afraid to talk about it to your healthcare provider. Some women might feel a bit embarrassed by issues affecting their vagina, but it helps to remember that this is something your doctor sees regularly. You might request a female doctor if that makes you feel more comfortable.
The longer you wait to seek treatment, the further away possible treatment is. Help is available, so see your GP.
- The Continence Foundation of Australia has good information on pelvic floor prolapse, including a video.
- A Queensland Health factsheet on pessaries and their use and care is available here: Care of your vaginal pessary (PDF 186kB)
- The Jean Hailes for women’s health website has comprehensive information including lifestyle and treatment options.