Vaginal prolapse is common, affecting up to half of adult women. Causes include pregnancy
and childbirth, aging and menopause, obesity, chronic cough, chronic constipation and
heavy lifting. It is a common condition and symptoms can be improved with physiotherapy
in many women.

What is a vaginal (pelvic organ) prolapse?

Your pelvic organs include your bladder, uterus (womb) and rectum (back passage). These organs are held in place by tissues called fascia and & ligaments. These tissues help to join your pelvic organs to the bony side walls of the pelvis and hold them inside your pelvis.
Your pelvic floor muscles also hold up your pelvic organs from below. If the fascia or ligaments are torn or stretched for any reason, and if your pelvic floor muscles are weak, then your pelvic organs might not be held in their right place and they may bulge or sag down into the vagina. This is known as a pelvic organ prolapse (POP). Prolapse can occur in the front wall of the vagina (cystocele), back wall of the vagina (rectocele), uterus (uterine) or top of the vagina (vault, following hysterectomy). To be classified as a prolapse the individual must be symptomatic.

What are the symptoms of prolapse?
There are a few signs that you may have a prolapse. These signs depend on the type of prolapse and how much pelvic organ support has been lost.
You might have:

  • a heavy feeling or dragging in the vagina
  • pressure or bulging in your vagina, often made worse with physical activities
  • sexual problems of pain or less feeling
  • less control with your bladder or bowels
  • your bladder might not empty as it should, or your urine stream might be weak
  • urinary tract infections might be reoccurring, or
  • it might be hard for you to empty your bowel.

These signs can be worse at the end of the day and may feel better after lying down.

What causes a prolapse?
Childbirth is the main cause of a prolapse.  On the way down the vagina, the baby can stretch and tear the supporting tissues and pelvic floor muscles. The more vaginal births you have, the more likely you are to have a prolapse.
Other things that press down on the pelvic organs and the pelvic floor muscles that can lead to prolapse are:

  • chronic coughing (such as smoker’s cough or poorly controlled asthma)
  • heavy lifting (washing baskets, supermarket bags or children), and
  • constipation – chronic straining to empty the bowel can cause prolapse.

If any women in your close family have had a prolapse, you are also more at risk.

 

What can be done to prevent prolapse?
Having a strong pelvic floor can help to support your pelvic organs. Pelvic floor muscles, just like any other muscles, can be made stronger with the right exercises. It is important to have your pelvic floor muscle training checked by an expert such as a pelvic floor physiotherapist and start you on the right path.
By addressing these above factors (chronic cough, heavy lifting and chronic straining) you can help to prevent a prolapse from occurring.

 

What are my treatment options?
Lifestyle changes to stop doing the things that may cause the prolapse or make it worse. This can include losing weight, quitting smoking, eating and drinking differently, lifting less and avoiding constipation. Physiotherapy to strengthen the pelvic floor that supports your organs. A physiotherapist can design a special pelvic exercise program for you.

A pessary (a small plastic or silicon support) that is placed inside your vagina to hold up the prolapsed organ. Pessaries don’t fix prolapses but they can reduce or lessen the symptoms of prolapse and help you live more comfortably. This can be fitted by some Women’s Health Physiotherapists.

Surgery to repair the torn or stretched pelvic floor. There are several types of prolapse surgery but all of them try to fix the prolapse and prevent it from happening again. Some surgeries will mean you can no longer have children.
Treatment is not always successful and sometimes a prolapse will come back.

After surgery:
To prevent prolapse coming back again, you should make sure you:

  • have expert training to make sure your pelvic floor muscles work to support your
    pelvic organs
  • don’t strain when using your bowels
  • keep your weight within the right range for your height and age
  • learn safe ways of lifting, including sharing the lifting of heavy loads
  • see your doctor if you have a cough that won’t go away, and
  • see your doctor if simple things don’t seem to make it better.

 

Eleni Cody

Women’s Health Physiotherapist

Eleni Cody