Pelvic Organ Prolapse

The pelvic organs (bladder, womb, vagina and bowel) are supported and kept in place by the pelvic floor muscles and surrounding tissues. Sometimes these muscles and tissues develop problems and one or more of the organs may no longer sit in the ideal position and droop. They may bulge into the vaginal canal or even externally. This affects about one third of women over their life time.

What are the symptoms of vaginal prolapse?

You could have one or more of these symptoms

• a feeling of something coming down, a dragging sensation or a bulge in the vagina
• difficulty emptying your bladder or bowel
• discomfort / pain during sexual intercourse
• discomfrt or aching int eh pelvic and low backache

What causes pelvic organ prolapse?

Anything that puts increased pressure on the abdomen can lead to pelvic organ prolapse including:

• Pregnancy and childbirth
• Getting older
• Being overweight
• Respiratory problems with a chronic long term cough
• Constipation
• After a hysterectomy (surgical removal of the womb/uterus)
• Heavy lifting
• Genetics play a roll

Some of the most common vaginal prolapse:

• Anterior vaginal prolapse: where the anterior vaginal wall does not adequately support the bladder. This can make it difficult to fully empty the bladder, increasing risk of urinary tract infections, and can lead to an increase in symptoms of urgency
• Posterior vaginal prolapse: the posterior vaginal wall doesn’t adequately support the bowel. This can make it difficult to initiate emptying or fully empty with ease
• Uterine prolapse: the cervix and uterus descend into the vaginal canal

The rectum can also prolapse through the back passage (rectal prolapse).

Self Help Tips

• Limit heavy lifting where you need to strain. Avoid holding your breath. Lifting from ground level is harder than from waist height.
• When it can’t be avoided, before lifting, engage your pelvic floor muscles. Lift with a good posture.
• Avoid constipation
• Sitting position on the toilet is really helpful:
  • Ideally knees should be higher that hips
  • Lean forward with a straight back
  • Avoid straining
  • Do not hold your breath, try to breath out as you let go
• Support underneath using your hand or a finger or thumb internally, to help you empty your bowels
• Rock back and forward after going to the toilet to fully empty. i.e. double void.
• Maintain a healthy weight
• Strengthen your pelvic floor muscles, this may be easier in lying initially.
• If feeling particularly heavy, lie down, knees bent, with a pillow under your bottom to allow gravity to reduce the heaviness.  Do some pelvic floor exercises in this position.
• Exhale with every effort.  Never hold your breath or pull your tummy in strongly during an exercise

What is a Vaginal Pessary?

It is a silicone or plastic device, which is inserted into the vaginal to hold a prolapse uterus or vaginal wall in place and support your bowel and bladder.  Once correctly fitted it may help to reduce your symptoms and make you feel more comfortable.  There are different types of pessary and it can take more than one visit to get the right size, fit and type for you.

For more info please visit the Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) site POGP Pessaries for Prolapse - Patient Information

Pessaries for Prolapse | POGP (thepogp.co.uk)

Patient Leaflets

• Pelvic Organ Prolapse
• Pelvic Floor Exercises for Women
• Pelvic Floor Muscle Exercises and Advice - A guide for trans men, trans masculine and non-binary people (who were assigned female at birth)
• Being Active with Bladder and Bowel Issues
• POGP Prolapse leaflet
• RCOG Pelvic Organ Prolapse Patient Leaflet