Pelvic Organ Prolapse

Pelvic organ prolapse is descent of any of the pelvic organs (bladder, uterus or bowel) into the vagina.

It is a condition that affects up to 50 percent of women that have had children. It is strongly associated with vaginal births; other risk factors include pregnancy and things that increase the intra-abdominal pressure such as obesity, chronic constipation, chronic coughing, and prolonged standing.

It is not considered a life threatening condition but it can have an enormous effect on a women’s quality of life.

Symptoms can include:

  • Vaginal Bulging: feeling of a ‘bulge’ or something coming down through the vagina
  • Pelvic Pressure: heaviness or dragging in the pelvic area
  • Splinting/digitations: needing to apply manual pressure with fingers to move the prolapse, usually to assist urinary voiding or defecation
  • Low back ache: low, sacral ache similar to period pain
  • Urinary hesitancy, slow urine stream, history of urinary tract infections, post defecation soiling

The undamaged female pelvis has the bladder sitting at the front of the pelvis close to the pubic bone. The urethra is the channel between the bladder and the outside of the body.

The uterus shown in the picture is anteverted and sits on top of the bladder. The uterus may also be retroverted which is a normal variation. The uterus is where a growing foetus develops. The vagina is the passageway from the outside of the body ending at the cervix. At the entrance it is orientated upwards and backwards and then becomes almost horizontal.

Behind the vagina is the anal canal and rectum. The rectum is the lower end of the digestive tract where faeces are stored and the anal canal is the passageway through which they are expelled.

The pelvic floor muscles and fascia(strong connective tissue) play an important role in keeping all of these structures in place. Damage or weakness of the pelvic floor complex can result in prolapse.

Types of Prolapse

Anterior (front) vaginal wall prolapse / cystocele

Occurs when the supporting muscles or fascia(storng connective tissue) between the vagina and bladder is damaged. The structures may be torn or stretched resulting in the bladder and/or urethra prolapsing backwards into the vagina. It can cause incontinence or symptoms of increased urinary frequency, or problems with urinating.

Posterior (back) vaginal wall prolapse / Retocele

Occurs when the supporting muscles or fascia between the vagina and rectum are damaged. It results in the rectum prolapsing forwards into the vagina. This can cause problems when trying to defecate.

Apical / Uterine / cervical prolapse

Occurs when there is damage to the support ligaments of the uterus and cervix or upper vaginal fascia. Descent of the uterus can cause problems with urinating, defecating and can be a source of sexual pain or a feeling of heaviness or dragging in the pelvis.

Vaginal Vault prolapse

After a hysterectomy, the uterus is removed and the top of the vagina stitched together. A vault prolapse is when the top of the vagina starts to invert and descend down through the vagina

Prolapse can be treated by surgical repair or conservatively. You should not ignore symptoms, as they typically worsen over time. Your women’s health physiotherapist can help with conservative treatment, including pelvic floor strengthening, fitting vaginal support pessaries, and lifestyle modifications. Surgery should be discussed with your gynaecologist.