Pelvic organ prolapse is the dropping or bulging of one or more of the pelvic organs into the vagina or rectum. These organs are the uterus, bowel and bladder.
Symptoms may include a sensation of a bulge or something coming down or out of the vagina, discomfort during sex or inserting a tampon, problems passing urine – such as slow stream, a feeling of not emptying the bladder fully, needing to urinate more often and leaking a small amount of urine when you cough, sneeze or exercise (stress incontinence).
You may experience some of these symptoms for other reasons than a prolapse – so it would need to firstly be confirmed by a specialist. If it is confirmed, it will usually be staged to indicate how severe it is. Most often, a number system is used, ranging from one to four, with four indicating a severe prolapse.
Different types of prolapse
Pelvic organ prolapse can affect the front, top or back of the vagina. The main types of prolapse are:
- Anterior prolapse– Where the bladder bulges into the front wall of the vagina.
- Prolapse of the uterus and cervix or the top of the vagina itself.
- Posterior wall prolapse – When the bowel bulges forward into the back wall of the vagina or rectum.
It’s possible to have more than one of these types of prolapse at the same time.
Prolapse is primarily caused by weakening of tissues that support the pelvic organs. As well as a weakening of the supportive tissues, increased pressure from above in the tummy or even in the chest can also increase chances of a prolapse. Although there’s rarely a single cause, the risk of developing pelvic organ prolapse can be increased by your age, childbirth, menopause, being overweight, previous pelvic surgery, repeated heavy lifting and manual work, long-term coughing or sneezing, or excessive straining when going to the toilet because of long-term constipation.
How to reduce your risk of prolapsing
There are several things you can do to reduce your risk of prolapse, including regular pelvic floor exercises, maintaining a healthy weight, eating a high-fibre diet to avoid constipation and straining when going to the toilet, as well as avoiding heavy lifting if you are not conditioned to it or have a big ‘bracing’ technique.
Many women with prolapse don’t need treatment, as the problem doesn’t seriously interfere with their normal activities. Pelvic floor exercises are usually recommended in mild cases. In more severe cases, surgery is need to restore the normal position of the pelvic organs, and to help re-support the tissues.
You may also want to change the way you practise your pelvic floor exercises by adjusting your position.
For Anterior prolapse– where the bladder bulges into the front wall of the vagina and for prolapse of the uterus and cervix or top of the vagina, try elevating your legs and placing a pillow underneath your pelvis. This can be more of a comfortable position to use during pelvic floor exercises and can help relieve the feeling of the internal organs bulging into the vagina making it easier to practice your pelvic floor exercises.
For posterior wall prolapse – When the bowel bulges forward into the back wall of the vagina, try using a Pilates ball to rest on so that you are ‘bottoms up’. This can be a far more comfortable position for pelvic floor exercises as it can ease the symptoms of bulging around the anus, making it easier to practice.
Don’t have a ball? Try going onto forearms and knees to create a similar position.
If you are concerned that you may have some form of prolapse, it is definitely recommended that you see a specialist for confirmation and diagnosis of the type and the severity of prolapse. This is especially true if you are planning on either getting back to exercise and/or thinking of having more children.