What is a Pelvic Organ Prolapse (POP)
A prolapse occurs when one or more of the pelvic organs sag or bulges into the vagina.
The pelvic organs consist of the bladder, bowel and uterus. These are held in place by connective tissue structures known as “ligaments” or fascia”. The pelvic floor muscles provide support from below. When there is damage or stretch to the connective tissue structures, one or more of the pelvic organs can sag into the vagina.
Women with a prolapse require a thorough examination of the prolapse and the associated symptoms by a doctor or a physiotherapist training in pelvic health.
Types of Prolapse
Anterior prolapse (or Cystocele) - the bladder sagging into the front wall of the vagina
Posterior prolapse (or Rectocele) - the bowel sagging into the back wall of the vagina
Apical prolapse (or Uterine) - the uterus sagging into the top part of the vagina
Vaginal vault - the top part of the vagina sagging down (in the case for women who have had they uterus removed)
Prolapses are graded from 1 (less severe) to 4 (most severe)
Common Symptoms:
A bulging or heaviness feeling inside the vagina
Seeing a bulge coming out of the vagina
A feeling of a “golf ball in my vagina”
A feeling of “something coming out of my vagina”
Obstructive defecation (difficulty doing a poo)
Incomplete emptying bladder or bowel - problems peeing or pooing
Feeling heavy or dragging in the lower abdomen
Discomfort with sex
Low back pain
What causes a Prolapse?
Childbirth (Vaginal) - e.g if a woman experienced a long pushing stage or interventions where required like forceps
Chronic heavy lifting
Chronic coughing or straining
Hormonal changes e.g. menopause
How can I fix my prolapse?
The management option for prolapse depends greatly on the type and severity of prolapse. As well as the activity level or aggravating factors for the person. An individual approach is best for women with prolapse but here are some management options listed below. Physiotherapists working in pelvic and women’s health are well placed to diagnose and manage prolapses and often will work in conjunction with GPs or Gynaecologists for management.
Treatment options include:
Do Nothing - After understanding their own prolapse, its severity and the treatment options available. A woman may decide not to do any treatment and will consider revisiting it later in life if symptoms and/or their prolapse worsens.
Non-surgical treatments
Lifestyle changes e.g. weight loss, advice around exercise and weight lifting, reducing constipation
Pelvic floor exercises - individualised prescription is beneficial for improving outcomes
Vaginal pessaries - objects placed inside the vagina to support the pelvic organs. These are safe to be worn short or long term and there is a growing body of evidence supporting the use of pessaries for prolapse management. At Evolve, the team works closely with gynaecologists to provide pessary fitting.
Topical oestrogen - prescribed by a GP, this can reduce symptoms of vaginal dryness and irritation
Surgery - surgical options can include either using your own tissue, biological tissue or synthetic mesh. Your doctor should explain the type of surgery suitable for your type of prolapse whilst also taking into consideration general health and risk factors.
Women’s and Pelvic Health Physiotherapists are a valuable addition to the multidisciplinary team in managing prolapse. Come and meet our friendly and skilled therapists.
This information is general in nature and does not constitute medical advice. It is always recommended that you seek input from your medical professional when any symptoms are present.
Written by Emily Wong, Clinical Manager and Senior Physiotherapist Joint Dynamics Evolve
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