Around 40% of women aged over 50 in the UK have a pelvic organ prolapse. This refers to one or more of your pelvic organs — your bladder, bowel or womb — bulging into your vagina.
Although it doesn’t always cause symptoms, you may experience discomfort, pain and/or a dragging sensation in your vagina as if something is coming down or pushing out. You may also develop urinary incontinence, where you leak urine or have sudden, uncontrollable urges to urinate, and experience pain or discomfort during sex.
There are different types of pelvic organ prolapse, depending on the organ that is pushing into your vagina, and in most cases it can be treated without surgery.
If you’re concerned that you have a pelvic organ, see your GP. They will ask you about your symptoms and also perform a physical examination of your pelvis. They may also refer you for tests to check the strength of your pelvic floor muscles (which support your pelvic organs) and the function of your bladder.
Depending on the results of your examination and tests, you may be diagnosed with one of several different types of pelvic organ prolapse. A cystocele prolapse involves your bladder, a rectocele prolapse involves your back passage (rectum) and a uterine prolapse involves your womb. If you have had a hysterectomy, you may develop a vault prolapse where the top of your vagina collapses down into the lower part of your vagina (vaginal canal).
Not all pelvic organ prolapses cause symptoms and in cases where your quality of life is not affected, you may not need any treatment. However, if your prolapse is causing you problems, your doctor may recommend pelvic floor training, where a physiotherapist will prescribe a programme of pelvic floor exercises to strengthen these muscles.
Your doctor may also recommend hormone therapy (eg vaginal oestrogen cream) to reduce symptoms associated with a prolapse, such as vaginal dryness and pain during sex. Vaginal pessaries may also be prescribed to support the pelvic organ bulging into your vagina. Vaginal pessaries come in different shapes, are made of plastic or silicone and are inserted into your vagina.
When is surgery needed?
If these treatments aren't effective and your quality of life is reduced, your doctor may recommend surgery. There are different types of surgery for pelvic organ prolapses.
This includes surgery to lift and support prolapsed organs, hysterectomy for women who have a uterine prolapse and don’t want to have any or more children, and in severe cases, surgery to close part or all of your vagina. Vaginal mesh surgery is currently not recommended unless there are no other alternatives.
Miss Roopa Nair is a Consultant Gynaecologist and Urogynaecologist at Spire London East Hospital, Spire Hartswood Hospital, and Barking, Havering and Redbridge University Hospitals NHS Trust. She specialises in endometrial ablation surgery, hysterectomy and hysteroscopy, laparoscopy investigations and treatment, ovarian cyst removal and urinary incontinence. She also holds a Masters in Minimally Invasive and Robotic Surgery from Anglia Ruskin University, has completed advanced training in urogynaecology and vaginal surgery, and is the Lead for urogynaecology services at her NHS Trust.
If you're concerned about symptoms you're experiencing or require further information on the subject, talk to a GP or see an expert consultant at your local Spire hospital.