Pelvic organ prolapse

Pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina.

It can be the womb (uterus), bowel, bladder or top of the vagina.

A prolapse isn't life-threatening, but it can cause pain and discomfort. Symptoms can usually be improved with pelvic floor exercises and lifestyle changes, but sometimes medical treatment is needed.

Symptoms of pelvic organ prolapse

Pelvic organ prolapse symptoms include:

• a feeling of heaviness around your lower tummy and genitals (pelvis)
• a dragging discomfort inside your vagina
• feeling like there is something coming down into your vagina – it may feel like sitting on a small ball
• feeling or seeing a bulge or lump in or coming out of your vagina
• discomfort or numbness during sex
• problems peeing – such as feeling like your bladder isn't emptying fully, needing to go to the toilet more often, or leaking a small amount of pee when you cough, sneeze or exercise (stress incontinence)

Sometimes pelvic organ prolapse has no symptoms and is found during an internal examination carried out for another reason, such as cervical screening.

When to see your GP

See your GP if you have any of the symptoms of a prolapse, or if you notice a lump in or around your vagina.

What happens at your appointment

Your doctor will ask if they can do an internal pelvic examination.

For this you will need to undress from the waist down and lie back on the examination bed. Your doctor will then feel for any lumps in your pelvic area and inside your vagina. They may gently put an instrument called a speculum into your vagina to hold the walls of it open so they can see if there is a prolapse.

Sometimes they will ask you to lie on your left-hand side and examine you in that position to get a better view of the prolapse.

Some women may put off going to their GP if they're embarrassed or worried about what the doctor may find. However, the examination is important. It only takes a few minutes and is similar to having a smear test.

You can ask for this examination to be done by a female doctor and, if you like, bring someone you trust along with you for support.

Further tests

If you have problems with your bladder, your GP may refer you to hospital for further tests. These may include:

• a urine test to look for an infection
• inserting a small tube into your bladder to look for any problems

Treatment for pelvic organ prolapse

If you don't have any symptoms, or the prolapse is mild and not bothering you, you may not need medical treatment. But making some lifestyle changes will probably still help.

If the prolapse is more severe, or your symptoms are negatively affecting your daily life, there are several medical treatment options to consider, including:

• lifestyle changes, such as stopping smoking, losing weight and pelvic floor exercises
• hormone treatment
• vaginal pessaries
• surgery

The recommended treatment will depend on the type and severity of the prolapse, your symptoms and your overall health. You and your doctor will decide together what is the best option for you.

Read more about treatment for pelvic organ prolapse.

Causes of pelvic organ prolapse

Pelvic organ prolapse happens when the group of muscles and tissues that normally support the pelvic organs, called the pelvic floor, becomes weakened and can't hold the organs in place firmly.

A number of things can weaken your pelvic floor and increase your chance of developing pelvic organ prolapse, including:

• pregnancy and childbirth – especially if you had a long, difficult birth, or if you gave birth to a large baby or multiple babies
• getting older and going through the menopause
• being overweight or obese
• having long-term constipation or a long-term condition that causes you to cough and strain
• having a hysterectomy
• a job that requires a lot of heavy lifting

Some health conditions can also make a prolapse more likely, including:

• joint hypermobility syndrome
• Marfan syndrome
• Ehlers-Danlos syndromes

Types of prolapse

The 4 main types of prolapse are:

• the bladder bulging into the front wall of the vagina (anterior prolapse)
• the womb bulging or hanging down into the vagina (uterine prolapse)
• the top of the vagina (vault) sagging down (vault prolapse) – this happens to some women after they have had surgery to remove their womb
• the bowel bulging forward into the back wall of the vagina (posterior wall prolapse)

It's possible to have more than one of these at the same time.

Pelvic organ prolapse will usually be classified on a scale of 1 to 4 to show how severe it is, with 4 being a severe prolapse.