Pelvic organ prolapse

The pelvis is the area of the body between the hips. In women, there are three main organs located within the pelvic area which may become prolapsed:

• The uterus
• The bladder
• The rectum (part of the bowel)

These organs are held in place by muscles and ligaments, collectively known as the pelvic floor. The pelvic floor, including the walls of the vagina, can be weakened by over-stretching, natural ageing and the effect of hormones. If this happens one or more pelvic organs can move from their natural position and bulge into the vagina.

Pelvic organ prolapse is most likely to affect women aged 50 and over.

A pelvic organ prolapse may cause pain or discomfort but can often be rectified with lifestyle changes and simple treatments. However, you may need surgery if the prolapse causes distress and affects your quality of life.

Symptoms of a pelvic organ prolapse include:

• A dragging sensation or discomfort in your pelvic area
• Feeling or seeing a bulge or lump in your vagina (sometimes a prolapse can protrude)
• Feeling that your bladder isn't emptying properly
• Stress urinary incontinence (urine leaks when you cough or laugh)
• Needing to urinate more often than usual
• Pain or lack of feeling during sex

Sometimes a pelvic organ prolapse produces no symptoms at all.

Visit your GP if you have any of the above prolapse symptoms. They'll discuss your medical history and perform an internal examination of your pelvic area. You may also have one or more of the following:

• Bladder function tests to check how well your bladder is working
• Pelvic floor strength tests to check how well your pelvic organs are supported

Occasionally, your doctor may want to get an image of your pelvic area by using an MRI scan or an ultrasound scan.

Certain things can weaken your pelvic floor, increasing your chance of developing a pelvic organ prolapse. These include:

• Ageing or menopause, which causes loss of natural muscle tone and hormones
• Being overweight
• Long-term constipation
• Coughing for long periods of time
• Having a hysterectomy
• Activities that involve straining or lifting

If you experienced difficult or multiple births and had large babies, you might go on to have a prolapse in later life.

If you have prolapse symptoms, your doctor will recommend:

• Pelvic floor exercises designed by a physiotherapist to strengthen muscles
• Hormone therapy (eg vaginal oestrogen cream)
• Vaginal pessaries (devices inserted into the vagina to support your prolapsed pelvic organs)

They may also suggest other things including:

• Stopping smoking
• Losing weight
• Managing other conditions that make your prolapse worse, such as constipation or coughing

Surgery is available if non-surgical treatments haven't worked.

Usually, this will mean repairing the prolapse by lifting and re-fixing the pelvic organs. There are different minimally-invasive types of surgery used.

A hysterectomy may be recommended to relieve pressure on the top of the vagina, but only for women who no longer want to have children or have been through the menopause.

In severe cases, or for those unable to have complex surgery, an operation to close the vagina may be offered.

Vaginal mesh

In the last few years, newer treatment options emerged involving the use of “mesh” to support the vaginal wall and other organs. While many women have benefited from this type of treatment, there have been reports of complications. Vaginally inserted mesh for the treatment of pelvic organ prolapse is no longer considered a primary surgical option. Since 11 July 2018, these operations have been paused while an independent review assesses the risks and benefits and to confirm that extra safety measures have been put in place.