Usually the bladder, uterus and lower portion of the bowel are well supported in the pelvis. However, if there is a lack of support in the surrounding tissues, one or more of these organs may descend into the vagina, which is known as a Pelvic Organ Prolapse, or simply a Prolapse.
Women may notice vaginal symptoms such as heaviness, a dragging sensation, or a feeling of something bulging down into the vagina. Other signs of a prolapse may be difficulty emptying the bladder or bowels, difficulty using tampons, lower back or abdominal muscle discomfort, or sexual symptoms such as pain, discomfort or loss of sensation.
Prolapse is a more common issue that you may realise – in fact, 50% of women who have given birth will have a prolapse. This risk is increased, but not confined to, those who have had a vaginal birth.
Women who have not had children are not immune to prolapse either - there are many other risk factors. These include women who regularly increase the pressure in their abdomen, such as those suffering from chronic constipation, those who lift heavy weights regularly at work or at the gym, and those who suffer with chronic coughing or sneezing. Other factors contributing to prolapse are ageing and menopause, being overweight, previous pelvic surgery (especially hysterectomy), and whether you have a family history of prolapse.
You will not necessarily require surgery if you have a prolapse.
Many prolapses are small enough to trial a period of conservative management before considering surgery. Women’s Health and Continence Physiotherapists have specific qualifications to assess your individual presentation and put in place a management plan. Conservative management involves putting in place strategies to reduce intra-abdominal pressure in daily life (for example a safe exercise regime, weight management and correct bladder and bowel emptying techniques), pacing activities throughout the day, and pelvic floor muscle training.
Pelvic floor muscle training, when implemented by a Physiotherapist with specific qualifications, is recommended as first line therapy for prolapse management, and has been shown to be effective in reducing prolapse symptoms and severity. An internal support device, known as a vaginal pessary, may also be recommended alongside pelvic floor muscle training
If approximately 6 months of well-supervised conservative management is not adequate, then you should be referred to a gynaecologist for further assessment. Surgery may be considered at this point. If surgery is required, reducing ongoing intra-abdominal pressure and keeping your pelvic floor muscles functioning well are essential for good long term outcomes.