HealthInfo Canterbury

Pelvic organ prolapse

A pelvic organ prolapse is when the tissues and muscle that support the pelvic organs become weak, causing them to drop down and bulge into your vagina. There are several different kinds of prolapse, depending on which organ has dropped. If it's your uterus, it's called a uterine prolapse. If it's your bladder, it's called a cystocele. If it's your rectum, it's called a rectocele.

Causes of pelvic organ prolapse

Anything that weakens or stretches your pelvic floor muscles and ligaments can increase your risk of getting a prolapse. This includes:

• pregnancy and childbirth – due to the weight of your baby, hormone changes, labour and delivery
• constipation – regular (chronic) straining on the toilet to do poos (defecate)
• being overweight
• repetitive heavy lifting
• regular coughing or sneezing such as from smoking, asthma, hay fever
• ageing, which causes loss of muscle tone
• menopause – lower levels of estrogen make your muscles less elastic
• previous pelvic surgery – this may damage nerves and tissues in your pelvic area.

Symptoms of pelvic organ prolapse

Depending on which organ has prolapsed, you could experience:

• a feeling of heaviness or pressure in your lower tummy
• a feeling of a bulge or something coming down or out of your vagina
• discomfort during sex
• difficulty doing poos
• wee (urine) leaking when you cough, sneeze or exercise (known as stress incontinence)
• problems when you wee (urinate), such as the wee coming in a slow stream or a feeling of not fully emptying your bladder.

Sometimes there are no symptoms and the prolapse is only discovered during a pelvic examination or cervical screening.

Diagnosing pelvic organ prolapse

Your doctor will ask you about any symptoms you have and how they affect your daily life. They'll usually do a pelvic examination and may also look at your cervix using an instrument called a speculum, which they put into your vagina.

Treating pelvic organ prolapse

The way a prolapse is treated depends on what type you have and how much it's affecting you.

Your doctor may recommend changes to your lifestyle, such as maintaining a healthy weight, keeping active, quitting smoking and bladder retraining. You should avoid heavy lifting and getting constipated. You can try exercises to strengthen your pelvic floor muscles.

If you have a vaginal prolapse and you've been through menopause, your doctor might prescribe vaginal estrogen cream.

If you still have problems, they may suggest you try a vaginal pessary. This is a silicone or plastic removable device that fits into your vagina and adds support to the walls of your vagina. If the pessary isn't successful, your doctor may refer you to a women's health physiotherapist to try a different type of pessary.

If none of these approaches work and your symptoms aren't improving and really harming your quality of life, you may be referred to a hospital specialist who will consider whether surgery would help.

  HealthInfo recommends the following pages

• Te Whatu Ora – Vaginal pessary for prolapse

  Information about vaginal pessaries, including benefits and possible side effects.

• Royal Australian and New Zealand College of Obstetricians and Gynaecologists – Pelvic organ prolapse

  Printable information about what a pelvic prolapse is, the different causes, types, available treatments and their risks.

• Royal College of Obstetricians and Gynaecologists – Pelvic organ prolapse

  Key points about pelvic prolapses, how they are diagnosed and treatment options.

• Medsafe – Surgical mesh implants

  Safety information on surgical mesh products in New Zealand.

Written by HealthInfo clinical advisers. Last reviewed September 2021.

Source

Page reference: 47494

Review key: HIPRO-12268