What is Pelvic Organ Prolapse?

Your pelvic organs include your bladder, bowel, rectum, uterus and vagina, which are supported underneath by your pelvic floor muscles.  The pelvic floor muscles extend from your pubic bone at the front to the tail bone at the back and to your sitting bones at the sides, like a trampoline. Connective tissue, fascia and ligaments also hold your pelvic organs in place. It will be helpful to follow this link to aid in understanding how the pelvic floor muscles support your pelvic organs http://www.thepregnancycentre.com.au/return-to-sport/articles/protect-your-pelvic-floor

Age, pregnancy, childbirth, vigorous high impact exercise, excessive lifting and constipation can stretch your supportive tissues.  If your pelvic floor muscles are also weak this may allow your pelvic organs to bulge down and prolapse into your vagina. Hormonal changes with decreased oestrogen in the peri and post-menopausal life stage can promote muscle weakness.

The name of the prolapse depends on the organ prolapsing. A bulge at the front of the vagina is usually called a cystocele. A bulge at the back is usually called a rectocele. When the uterus drops it to the vagina is a uterine prolapse.  Prolapses vary in severity from an internal bulge to bulging of organs outside the vagina to varying degrees.

anterior-wall-prolapse-copy

What are the symptoms of Pelvic Organ Prolapse?

Common symptoms may include one or more of the following:

  • Bulge or lump in the vagina
  • Heaviness or dragging in the genital area
  • Feeling of something falling out of the vagina
  • Feeling like you are not completely emptying your bladder or trouble starting the flow or weak stream
  • Feeling like you are not emptying your bowel completely
  • Sexual discomfort or reduced sensation
  • You may feel a bulge coming out of your vagina when you are cleaning yourself
  • Recurrent urinary tract infections

Some women will have a prolapse but will not have any symptoms

Who is at risk and how can pelvic organ prolapse be prevented

If you have family with prolapse, have given birth vaginally, are post-menopausal or have a history of constipation or heavy lifting you may be at increased risk of vaginal prolapse.  Consulting a pelvic floor physiotherapist for advice and to prescribe appropriate exercises may help reduce your risk of developing a pelvic organ prolapse.

How can Pelvic Floor prolapse be assessed?

If you have the above symptoms assessment usually requires an external and internal vaginal exam to assess where the prolapse is and to grade the severity.

How is pelvic floor organ prolapse treated?

When prolapses are moderate to mild the first line of treatment is non-surgical. This may include:

  • Individual pelvic floor training, prescribed by a pelvic floor physiotherapist. Training the pelvic floor muscles helps support the pelvic organs.
  • Lifestyle modifications, appropriate exercises and healthy eating
  • Using good bladder and bowel habits
  • Managing constipation
  • Pessary

If prolapse is severe or simpler treatments have not improved symptoms surgery may be considered.  Surgery attempts to repair the connective tissues, fascia and ligaments.  Be aware that surgery usually requires rehabilitation and long term activity modifications. Additionally 1 in 3 women that has prolapse surgery will prolapse again.

If you want to make an appointment or speak with one of our understanding, highly trained physiotherapists, please phone Physiotherapy for Women on (08)8443 3355.