What is pelvic prolapse and how can it be treated? We give you the rundown of what you need to know, plus expert advice and real mum’s experiences.
What is pelvic prolapse?
Pelvic prolapse is a disorder in which one or more of the pelvic organs drop from their normal position. It can thankfully be treated, but the course of treatment depends on the cause and the severity of the symptoms.
There was a time when pelvic prolapse was rarely discussed or even recognised as a condition, but thankfully it has become a priority in the area of women’s health.
According to the Continence Foundation of Ireland (CFI), 80% of women experience pelvic floor damage during the birth of their first baby. The pelvic floor is a group of muscles in your pelvic area. These muscles work to support the organs in your pelvis (bladder, uterus and rectum).
Pelvic relaxation is a weakness in the supporting structures of the pelvic region. Bladder, rectal or uterine tissue may then bulge into the vagina. This is called pelvic organ prolapse.
One in three women suffer from pelvic prolapse and up to 40% of women will experience some degree of incontinence in their lifetime. Nearly 10% of women will undergo surgery for urinary incontinence or pelvic prolapse, according to the CFI.
Real mum’s story
“I was diagnosed with an anterior and posterior prolapse (bladder and bowel) around a year after the birth of my second child. I went to my GP and was referred to a gynaecologist and a women’s health physiotherapist.
I had physio on my pelvic floor muscles and learned how to properly do pelvic floor exercises. I then saw the gynaecologist and had a pessary inserted to support the walls and help stop the dragging sensation.
I continued to have women’s health physio until they were happy with how well I was doing the exercises. I went down that route, as I wasn’t 100% sure if I was finished my family.
The gynaecologist said that becoming pregnant after surgery wasn’t a problem but it would most likely mean having the repair done again.
I went on and had another baby and after he was born I went back to have the pessary put in again while I waited to have the surgery. I had the anterior and posterior repair along with mesh for my bladder to stop unwanted leaks that I had been suffering from too.
The surgery was a success, but I have found that since I have gained weight, I have a slight dragging sensation – but it’s mostly when I do too much. I was also assessed by the women’s health physio six weeks after my operation and after I had seen the gynaecologist I was told my pelvic floor strength was at the top end of the scale. I chat to ladies from around the world on a private Facebook group. It’s great for support.”
Symptoms of pelvic prolapse
- The feeling of a bulge or something coming down or out of the vagina, which sometimes needs to pushed back.
- Problems with sexual intercourse.
- Recurrent bladder infections and stress incontinence.
- Feeling like you are sitting on a ball.
- Vaginal bleeding or increased discharge.
- Pulling or heavy feeling in pelvis.
Some women with pelvic prolapse may not have any symptoms and the condition is discovered during an internal examination or a cervical screening test.
Causes of pelvic prolapse
The main cause of prolapse is due to the weakening of tissues that support the pelvic organs. There is rarely a single cause, but your risk of developing the condition can be increased by:
- Increasing age – it becomes more common as you get older.
- Manual work and regular heavy lifting.
- Too much straining when going to the toilet because of constipation.
- Chronic coughing.
- Being overweight or obese.
- Damage to pelvic muscles and tissues during pregnancy and childbirth.
- The menopause – it can cause weakening of tissue and low levels of the hormone oestrogen
If you have any of the above symptoms of a prolapse or if you notice a lump in or around your vagina, you should see your GP. The condition is not life-threatening, but it can certainly affect your quality of life, so the sooner you get it seen to, the better. The examination is important and will only take a few minutes. Your GP will carry out an internal pelvic examination so that they can feel for any lumps in your pelvic area.
Treating pelvic prolapse
Women with no or very mild symptoms may not need treatment, but they are advised to avoid any activities that might worsen the prolapse. If necessary, losing weight, avoiding lifting heavy objects and quitting smoking can help to prevent pelvic prolapse from progressing. Pelvic floor exercises are also recommended in mild cases.
However, if the symptoms require treatment, a prolapse can be treated by using a device that is inserted into the vagina, called a vaginal pessary – which helps to hold the prolapsed organ in place.
The next option of treatment for some women is surgery, where support will be given to the prolapsed organ. Some women may need to have a hysterectomy (removal of the womb) – if the womb has prolapse.
How can pelvic prolapse be prevented?
- Doing regular pelvic floor exercises (see box to the right for instructions on how to do them).
- Staying at a healthy weight and losing weight if you need to.
- Following a healthy diet with lots of high-fibre foods including fresh fruit, vegetables, and wholegrain bread and cereal – to help to prevent constipation and straining when going to the toilet.
- Avoiding lifting heavy objects.
- Quitting smoking.
Dr Rachel Mackey
I do see quite a lot of pelvic prolapse, but it is more common in post-menopausal women as oestrogen protects quite a lot against prolapse. Younger women who are exercising tend to notice urine leakage (stress incontinence) rather than a feeling of something coming down, which is the main symptom associated with prolapse. Returning to exercise, like running or skipping, after a baby often reveals the incontinence. With prolapse and incontinence, which is too mild for surgery, physiotherapy is the main treatment and usually reverses mild symptoms. Also reducing weight and stopping smoking are really important as they both help to improve symptoms.
How to do pelvic floor exercises
Squeeze shut your back passage (as if holding back wind), your vagina (as if gripping a tampon) and your urethra (as if stopping your urine flow) and draw your pelvic floor inwards and upwards. Relax and let your pelvic floor lower again. Each squeeze should be held as long as possible and be as the strong as the one you held before. Take a few seconds to rest between each squeeze. You can do these exercises at any time during everyday activities.
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