25 Jul 2022

What is a prolapse and what can I do to help my symptoms?

Prolapse is when one or more of the pelvic organs move down into the vagina. This can sometimes happen at the time of the menopause due to the decrease in oestrogen.

Pelvic organ prolapse is common, affecting up to 50% of women who have had a child with 1 in 5
being symptomatic. A prolapse is when one or more of the pelvic organs move down into the vagina.
This can sometimes happen at the time of the menopause due to the decrease in oestrogen.
It is not life threatening, but for some people it can cause discomfort or pain and for some they may
have no symptoms. For some, symptoms may fluctuate day to day, or you may find you are okay in
the morning and quite uncomfortable by the end of the day.

What are the different types of prolapse?

There are four main types of prolapse:

  1. Anterior wall prolapse (cystocele) where the bladder bulges into the front wall of the vagina.
  2. Posterior wall prolapse (rectocele) where the bowel bulges forwards into the back wall of
    the vagina.
  3. Uterine prolapse where the womb moves down into the vagina.
  4. Vault prolapse where the top of the vagina hangs down into the vaginal cavity. This occurs
    after having a hysterectomy (surgery to remove the womb)

You can have a combination of more than one type of prolapse at the same time.

Common symptoms of a prolapse:

  • A feeling of heaviness or dragging around the vaginal area
  • A physical bulge coming into or past the entrance of the vagina
  • Difficulty emptying your bladder or bowels, depending on where the prolapse is, leading to a
  • feeling of still needing to pass urine or stool
  • Discomfort during penetrative sex
  • Lower back and or abdominal aching
  • Symptoms vary from person to person and the more severe your symptoms does not necessarily
  • mean the more severe the prolapse.

What causes a prolapse?

A prolapse occurs when the ligaments and muscles that support your pelvic organs become

weakened and cannot support them in place. Often it is a combination of factors that lead to a

prolapse.

They include:

  • Pregnancy and childbirth (you can still have a prolapse following a caesarean section)
  • Being overweight
  • Previous surgery or trauma
  • Ageing
  • Going through menopause
  • Chronic constipation and straining to open your bowels
  • Chronic cough
  • Heavy lifting due to occupation or exercise
  • Health conditions such as joint hypermobility, Marfans syndrome, Ehlers-Danlos syndrome,

Related article: Pelvic Health: It's no laughing matter (or is it?)

What can I do about a pelvic prolapse?

If you are not bothered by symptoms but you have been told that you have a prolapse you may not
need any specific treatment. However, you can make some changes to your lifestyle what will still be
very beneficial.
These include:

  • Weight loss if you are overweight
  • Adapting your work load or exercise programme to avoid or reduce heavy lifting
  • Avoiding and treating constipation

If your symptoms are more bothersome and affecting your daily life or ability to stay active, then the
first line of treatment is Physiotherapy. You would benefit from seeing a specialist Pelvic Health
Physiotherapist who will be able to complete a thorough assessment and guide you with your
rehabilitation. They would also be able to discuss the use of hormonal treatment, vaginal pessaries,
and the potential surgical options you may want to consider in the long term if more conservative
measures do not completely resolve your symptoms. Surgery is normally recommended to help
manage symptoms rather than based on the severity of the prolapse.

Vaginal oestrogen therapy

As we go through perimenopause and beyond the levels of oestrogen in our body reduce. Vaginal oestrogen therapy can be used to help keep the vaginal walls healthy. It helps to reduce thinning of the tissue and surrounding supportive structures that hold the pelvic organs in place. This can therefore can also help to reduce symptoms of a prolapse. They are a topical medication which means that it only affects the area it is applied to and does not go into your blood stream. 

If you are peri menopause or post menopause then it is important that you are using a vaginal oestrogen if you would like to have a pessary fitted. 

Related article: 10 nutritional tips for a happy and healthy pelvic floor

What is a vaginal pessary?


A vaginal pessary is a device that is inserted into the vagina to support the pelvic
organs in place. It is a low risk, conservative management option for a prolapse.
They come in a variety of shapes and sizes, as do our bodies, so the pessary used
will depend on your symptoms and degree / type of prolapse.

A pessary should not be felt once inserted. If you have a ring pessary fitted it can
stay in place for up to 6 months and does not need to be taken out to be cleaned,
however you can be taught to remove and reinsert it if necessary. You are safe to
have penetrative sex and use a tampon with a ring pessary in. If you have a cube
pessary fitted, then you would need to remove this for penetrative sex.

How can I get a pessary?


You can be assessed and if appropriate, fitted for a pessary by a specialist pelvic
health physiotherapist or a doctor (depending on your local area and what services
are available). You can be taught how to self-manage your pessary if you want to
remove and reinsert it. You would be reviewed every 6 months to have a new
pessary fitted and resized if necessary.

Complete Physio are offering - £10 discount on your first appointment with Women’s Health specialist physiotherapist Sophie Ellse

How do you know if you are going through perimenopause and menopause?

We have produced a symptom list to help you identify and track your own symptoms against the common list of symptoms.

DOWNLOAD FOR FREE NOW:

Sources

(1) Thacker, R. Stanton, S. Management of genital prolapse. BMJ 2002, 324
(7348) 1258-62
(2) Royal College of Obstetricians & Gynaecologists website
https://www.rcog.org.uk/
(3) Pelvic, Obstetric & Gynaecology Physiotherapy website
https://thepogp.co.uk/
(4) Sun Y, Chen H, Liu Y, Jiao R, Yuan J, Zhang X, Liu Z. Conservative
interventions for the treatment of pelvic organ prolapse: A systematic
review protocol. Medicine (Baltimore). 2019 Nov;98(47)
(5) NICE guideline [NG123] Urinary incontinence and pelvic organ prolapse
in women: management (2019)
https://www.nice.org.uk/guidance/ng123/resources/urinary-incontinence-and-pelvic-
organ-prolapse-in-women-management-pdf-66141657205189

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