Pelvic organ prolapse occurs when the pelvic muscles and ligaments are weakened, making them unable to hold the pelvic organs in place. The organs can then drop down into the pelvic area.

Women with prolapse often have a sense of heaviness in the vagina or pelvis. They may complain of feeling that they are “sitting on a ball”, or notice a bulge or mass protruding from the vaginal area while showering. Sometimes this feeling of heaviness or bulging is experienced more towards the end of the day, after working or standing all day. Other symptoms include discomfort during intercourse, urinary incontinence and bowel problems.

Some women may attempt to push the prolapsed organ back in to help when urinating, but may notice that the pressure is reduced on its own when they lie down at night. There are several different types of pelvic organ prolapse, with different names depending on the organs involved.

What causes pelvic organ prolapse?

Pelvic organ prolapse occurs when the muscles in the pelvic floor are stretched or aren’t strong enough to hold the pelvic organs in their correct position. It isn’t a life-threatening condition, but can cause pain and discomfort and have a major impact on your day-to-day quality of life.

Things that can cause the muscles in the pelvis to become stretched or weakened include:

• Pregnancy and childbirth
• Aging and menopause
• Obesity
• Fibroids or pelvic tumours
• Long-term (chronic) coughing Long-term (chronic) constipation
• Lifting heavy objects
• Certain genetic conditions
• Prior pelvic surgery
• Some neurological conditions or spinal cord injuries

The main types of pelvic organ prolapse are:

Bladder prolapse – Cystocele occurs when the bladder, which stores urine, slips down and pushes against the front of the vagina.

Rectum prolapse – Rectocele occurs when the rectum bulges into the back of the vagina.

Urethra prolapse – Urethrocele occurs when the urethra, which transports urine from the bladder and out of the body, slips and pushes against the lower part of the front of the vagina.

Vaginal vault prolapse – Vaginal vault prolapse occurs when the top of the vagina falls in on itself. This only happens if a woman has had a hysterectomy – an operation to remove the uterus.

Small bowel prolapse – Enterocele occurs when the small intestine drops down between the back of the vagina and the rectum. This may occur at the same time as prolapse of the uterus or rectum.

Uterus prolapse – Uterine prolapse occurs when the uterus (womb) drops down into the vagina.

Your doctor will assess which type of prolapse you may have. It is possible to have more than one type at the same time.

Normal female anatomy	Cystocele	Rectocele	Uterine prolapse

How do I know if I have pelvic organ prolapse?

The signs and symptoms of pelvic organ prolapse vary, depending on the type of prolapse and how advanced it is.

Mild prolapse may be experienced as a sensation of pressure or dragging in your pelvic area, particularly if you have been standing for a long time.

As the prolapse becomes more severe, you may feel more discomfort as well as one or more of the following symptoms:

• Problems controlling your bladder
• Difficulty urinating
• Leaking urine during everyday activities that put pressure on your abdomen (stress urinary incontinence)
• Constipation or other bowel problems
• Discomfort or pain in your lower pelvis
• Back pain
• A feeling that something is stuck or is  falling out of your vagina
• Discomfort or pain during intercourse
• A lump in your vagina
• Unusual bleeding or discharge

There are different treatment options available for pelvic organ prolapse. Your doctor will be able to help you find the best solution for you, according to the type and cause of the prolapse. They will also take into account your plans for the future, including whether you would like to become pregnant.

Treatment may start with non-surgical options such as Kegel exercises, a pessary (device worn in the vagina for support), oestrogen supplementation, electrical stimulation or biofeedback.

Kegels are exercises that can help strengthen your pelvic floor muscles. In mild cases of uterine prolapse, they may the only treatment needed. However, for them to be effective, they need to be done daily.

Vaginal pessary is a rubber or plastic device used to support the pelvic floor and the prolapsed organ. A doctor or healthcare professional will insert and fit the pessary, which must be cleaned frequently and removed before sexual intercourse.

Oestrogen replacement therapy may help to limit any further weakening of the muscles and connective tissues that support the uterus, bladder and rectum. However, there are some drawbacks to taking oestrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer.

You should discuss all treatment options available to you with your doctor.

Talk to your doctor to find out more about surgical options for treating prolapse.