Pelvic organ prolapse: what it is and what actually helps

This is a subject people find difficult to raise, which is unfortunate, because it is one of the most common conditions we treat and one of the most responsive to treatment. The NHS estimates that around half of women over the age of fifty have some degree of pelvic organ prolapse. A great many of them have never mentioned it to anyone.

What it is

Prolapse is when one of the pelvic organs, the bladder, the womb or the bowel, bulges into the vagina. The pelvic floor muscles and the supporting tissue that normally hold everything in place have stretched or weakened, and the organ moves down.

There are degrees of it. A mild prolapse may cause no symptoms at all and need nothing more than reassurance. A more significant one can affect daily life considerably.

What increases the chance of it

Pregnancy and childbirth are the most common factors. So is age and the hormonal change of the menopause. Being overweight adds load, as does anything that repeatedly raises pressure inside the abdomen, which includes long term constipation and straining, a persistent cough, and heavy lifting done regularly.

Previous pelvic surgery, including hysterectomy, is a factor. Some people also have a natural tendency towards it through the make-up of their connective tissue.

What it feels like

The commonest description is a dragging or heavy sensation low in the abdomen or in the vagina, often worse by the end of the day or after standing for a long time. Some women describe the feeling of sitting on a small ball, or notice a bulge they can see or feel.

There may be bladder symptoms, such as a sense that the bladder has not emptied fully, needing to go more often, or leaking when you cough, sneeze or exercise. There may be difficulty opening the bowels. Sex can be uncomfortable.

None of these symptoms on their own confirm a prolapse, and several of them have other explanations, which is why an assessment is worth having rather than self diagnosing from a list.

What helps

The first thing to say is that treatment is not a straight choice between doing nothing and having an operation, which is what many women assume.

Lifestyle changes come first and do more than people expect. Treating constipation so that you are not straining, managing a chronic cough, avoiding repeated heavy lifting, and losing weight where that is relevant all reduce the load on the pelvic floor.

Pelvic floor muscle training is the mainstay of conservative treatment and is recommended before surgery is considered. The important detail is that it has to be done correctly. A significant proportion of women doing pelvic floor exercises from a leaflet are not actually contracting the right muscles, and some are bearing down instead, which is the opposite of the intention. A pelvic health physiotherapist can assess the muscles directly, confirm that you are doing them correctly, and give you a programme that progresses rather than one you repeat at the same level indefinitely.

Vaginal pessaries, which are support devices fitted internally, are an effective option for many women and can be used alongside muscle training.

Vaginal hormone treatment may be recommended by your GP where the tissue changes of the menopause are part of the picture.

Surgery is available for more severe prolapse, and for some women it is the right answer. Even then, optimising pelvic floor strength beforehand is worthwhile, and for many it delays or removes the need for an operation altogether.

Getting seen

Our pelvic health physiotherapists see women for this every week, in confidence, and will talk through the options rather than pushing you towards one. Assessment includes an internal examination, with your consent, because that is the only reliable way to grade a prolapse and to check what the muscles are doing. You are welcome to bring somebody with you.

If your symptoms began after having a baby, the Mummy MOT postnatal assessment covers this alongside abdominal separation and general recovery, and postnatal rehabilitation follows on from it. If they have appeared or worsened around the menopause, our menopause and pelvic floor page covers that side of it.

Our page on what happens at your first visit explains how an appointment runs. Please do not sit with this for years on the assumption that nothing can be done.