Pelvic organ prolapse

Pelvic organ prolapse occurs when the pelvic organs such as the womb, rectum and bladder slips out of their normal position and into the vagina. This happens because the supporting tissues and ligaments have weakened. Stretching and slackening is a natural result of childbirth and prolapse often occurs in later life following protracted labour, large babies or the use forceps and vacuum extraction.

Pelvic Organ Prolapse Quantification SystemOccasionally prolapse may occur if there is an inherited weakness of the pelvic floor muscles or as a result of heavy lifting, chronic coughing and constipation. Obesity can add additional stresses to an already weak system of support as the extra weight presses on the bladder.

Finally it can happens as a natural result of the menopause as the muscles thin and become weaker.

It is estimated that up to 50% of women who have had children are affected by some degree of prolapse. It happens more frequently as women age and go through the menopause and it’s rare in women who haven’t had children. It is also the most common reason for women to have a hysterectomy when they are over 50 years of age.

The types of prolapse that can occur are:

They can occur separately or together and will occur to differing degrees.

Symptoms of pelvic organ prolapse

  • lump or bulge inside or outside the vagina
  • feeling of pressure in the vagina
  • recurring bladder infections
  • backache in the lower back
  • disturbance of bowel movements
  • need to urinate more frequently
  • incontinence to varying degree
  • stress incontinence
  • sexual discomfort
  • urge incontinence
  • overflow incontinence
  • total incontinence

All prolapses have different stages or degrees. Each of these requires a different type of intervention or treatment.

  • stage 1: the prolapse is more than 1cm above the opening of the vagina
  • stage 2: the prolapse is 1cm or less from the opening of the vagina
  • stage 3: the prolapse sticks out of the vagina opening more than 1cm, but not fully
  • stage 4: the full length of the prolapse bulges out of the vagina

In most cases of stage 1 and some stage 2 prolapses treatment will be things like weight loss and kegel exercises (pelvic floor exercises). It is also possible that HRT may be prescribed as this could have a beneficial effect on the pelvic floor muscles and surrounding tissues and ligaments

Many stage 2 and some stage 3 prolapses may required the insertion of a device called a vaginal ring pessary which can help to hold the prolapsed organ in its proper place

For most stage 3 and 4 prolapses it is likely that surgery will become necessary. This may involved insertion of a mesh to support the womb or even a hysterectomy. It is possible that women who have been treated may also need surgery to support the vaginal walls as well. There is no guarantee that surgery will solve all the symptoms of prolapse and in some cases it can make them worse.

What Treatment is Available?

Find out more about all the prolapse treatment options available.

The most common Drug Treatment is the use of hormone replacement therapy which is used to help restore the strength in the ligaments and muscles.

Surgical Treatment (Alternatives to Hysterectomy)

Surgical treatments are used to repair and restructure the ligaments and muscles and will depend on the type and amount of prolapse that has occurred. It includes vaginal repairs which involves the vagina being cut and folded over to create additional support. However, such repairs may impact on sexual activity, particularly where the vagina is narrowed or shortened.

Vaginal suspension (utero colpo sacro pexy)will use netting or leather to attach the top of the cervix or vagina to the top of the pelvis.

A Manchester procedure which partially amputates the elongated cervix and shortens the ligaments which support the uterus in its normal position.

Recommended Reading:

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Recommended Resources:

55 thoughts on “Pelvic organ prolapse

  1. hi im am up all night passing water iv have funny sensation bottom of mt stomach telling me i need a wee i would say its bottom of my stomach but would say my pelvis i notice to few times when i have diffulculty go for a number 2 what could it be dr prescribed tablets which did help for a while but back again its come my back is in two sometimes with it please help i hadhysterectomy over 20 yrs ago but this has been of on occuring for quite few years now

  2. I had a leak and a prolapse op and as my pelvic floor muscles were none existent they put like a elastic band to tighten and fixed the leak about a year and a half and I feel the pushing down again and can’t hold my wee even in short spaces I have piles and fishers so bleed when I go I am 47 and so fed up x

  3. i feel lika havea slight prolapse,sore tummy.andweeing and tthen havt to squeeze moreout .my back is sore and im veryy fed up i m waiting for a scan ihve had ebndometriosis befotre and a right ooferectmy, is it better to have it all out.x

  4. I have 2 boys and had a grade 3-4 rectocele and cystocele prolapse, I am on the waiting list they have asked me if I want a hysterectomy the trouble being I am only 35 not really sure I am ready for that? any thoughts would be welcome

    1. Hi Lilley
      I had a full hysterectomy when I was 48 and it was the best decision I have taken. If you are sure you do not want any more children then go for it!
      As soon as I had had it done, they put me on HRT patches and I had never felt better, no going through the change and enjoyed sexual relations more, bonus!

    2. Have any of these ladies heard of the Hideaway Prolapse Solution. My wife has been wearing it for months now and it does a great job of supporting a prolapse uterus, rectocele or bladder prolapse is what I read. My wife has a prolapse bladder and it works so well for her. She had failed surgery so the Hideaway device is the answer for her until she decides if she wants any further surgery. I think you should publish this reply to help other ladies who cannot wear a pessary, cannot have surgery and need an alternative support that works. All they have to do is google “Hideaway prolapse solution” to find this device. Our doctor approves of this device and he is recommending it to some of his other patients as well. Just thought my wife and I would share it with you. I found out it is patent pending and the testimonials are very, very good. Barry & Vicki

    3. I had rectocele and cystocele repair surgery just two weeks ago. I discussed the option of a hysterectomy with my surgeon but as I couldn’t see the benefit of it I refused it. I am of the opinion that if it isn’t part of the problem (which it wasn’t in my case) then leave well alone! My prolapsed were really bad but I figured I f he removed the uterus it would only cause potential collapse of the vagina later requiring further surgery. My advice to you is discuss it thoroughly with your surgeon and don’t be bullied into have a hysterectomy if it has no medical benefit to you.

  5. I had.a hysterectomy about 5yrs ago Lately I’ve been feeling like my bladder has fallen down I feel like peeing alot Sometimes.some pee comes out after I finish I feel like I have to poop and nothing comes.out I get constipated alot My lower back hurts and my lower abdomen feels full and heavy

  6. I think that I may have a prolapsed vagina. I have bad lower back pain, I’m peeing frequently, it feels like my vagina is going to fall out. I feel like I need to use the bathroom to poop but I don’t and I push and push thinking I’m constipated but only pee comes out and my stomach is severally swollen and very tight and hard and look like I’m 6 month’s pregnant. My breast are sore and the pain in my lower back is getting unbearable and I can’t sleep and I sit on the toilet for over an hour or more peeing then stop peeing but still have the urge to so I sit on the toliet and pee over and over again. I have no odor but I have noticed a white like milk substance inside of my vagina and I got a mirror and looked at my vagina and I don’t know how to explain what I see. It looks like like a baby penius is growing inside me or a like 2 little feet and when I enter my fingers inside to feel its very weird and moist and tight and I can feel a long tunnel at first I thought I had a tampon lodged inside me but no I don’t and it feels like a fluid sack inside it and I still feel like I need to poop but I just keep sitting on the toilet and peeing my ass is falling asleep and my legs from sitting on the toilet so long and my lower back is killing me and directly below my bra line would be but a little lower on my stomach is cramping and sore I had a slight fever of 99.9 im so embarrassed and worried about what could be wrong. Please if anyone has any idea of what is going on with my vagina and body please don’t hesitate to give me your thoughts and feedback and opinions on what to do. Thank you kindly.

    1. Hi ,your symptoms are exactly the same as mine ,I have been to the GP and he said it was a prolapse ,and sent me to see a gynocholgist ,who confirmed a prolapse,,,,I was prescribed hrt tabkets to insert into my vagina to strengthen the walls ,,,l know exactly how you feel ,needing to wee and being so constipated ,I was also prescribed a laxative drink ( Nasty taste) I’m on 3/4 a day ,,, the consultant said I wasn’t able to have the pesaree ring fitted as I was so small inside ,so at the moment it’s live with it ,,,,or surgary ,I see my consultant in September and if things remain the same I will be having the surgary ,,, I am age 70.

      1. I have the same symptoms as Dawn which you replied to but also with vaginal stinging which my doctor prescribed antibiotics.
        I had an hysterectomy 18 years ago and was fine because I was on HRT patches, but they took me off the HRT around 5 years ago and have had the weeing and poop problems on and off since.
        Did the Laxative drink help?
        I cannot get to see a GP were I live, but am seeing a Nurse Practitioner in a few days to see if I have a prolapse.
        Did you have the surgery? and if so did it work?……
        I am nearly 68

  7. I am 67 about13 years ago pessary was tried, but just wouldn’t stay in place. Saw gynae about 18 months ago who saw prolapsed and suggested vaginal suppositories to help.
    Have seen GPs twice, both times after a nasty cough and cold, first time she said it was significant but perhaps to wait until it was a nuisance, it is with bladder problems which I would love to be rid of. Second time she gave me the choice of going forward to see gynae with a view to hysterectomy and getting on the list. I want to be relieved of the symptoms but with grandchildren and farming I don’t want to be out of order for months, and don’t wait problems in the future. I feel I am between a rock and a hard place, would welcome ideas please

  8. I am 4 weeks post op. Had laproscopy vaginal asst.partical hystertomy. Feeling alot better, still get deep achey pelvic pain. Really bad after bowel movement. Bowels aren’t moving by themselves, eating high fiber drinking water,walking. Having to use enima. My first bowel movement was horrific, strained so bad lifted myself off toliet,thought I was going to pass out. I’ve been feeling weird in vaginal area,if I bend like it’s wide open. Strange feeling. Or pressure, I’ve felt there in shower but I can’t tell what’s causing this feeling. Go to doctor on the 8th. Praying everything normal.

  9. I had a hysterectomy nine years ago , a couple of years ago I have felt pressure and dragging when I have been stood at work for long periods of time , in the last couple of weeks I have had my muscles pushing down my vagina popping out , pain in the bottom of my back and tummy , feeling like pushing down my back passage I feel so bad at night I am not sleeping , been to the doctors she as said need to go back at the end of the day so she can see the lump coming out , so painful and getting me down , do you think I need another operation , as I had what they call a three in one job

  10. Hi July 2015, I had a hysterectomy, a little over 6 months., for a prolapsed uturus, Recent I’ve been experiencing some cramping 🙁 is this normal ?

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