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Pelvic Organ Prolapse

  • What is a Pelvic Organ Prolapse?

    Pelvic organ prolapse occurs when the pelvic organs drop from their original position in the pelvis. This is a very common condition, especially among older women. It occurs when the pelvic floor muscles become weak or damaged, and can no longer support the organs of the pelvis. The pelvic organ prolapse can involve any of the pelvic organs including the uterus (womb), ovaries and fallopian tubes as well as the rectum and bladder.

    There are several types of pelvic organ prolapse:

    • Bladder (cystocoele) – The bladder creates a bulge in the front vaginal wall
    • Rectum or large bowel (rectocoele) – The end of the large bowel (rectum) bulges through the back wall of the vagina. It is also possible for the rectum to fall out of the anus
    • Small bowel (enterocoele) – Part of the small intestine may slip down between the rectum and the back wall of the vagina
    • Urethra (urethrocoele) – The urethra (the tube that carries urine from the bladder) pushes through the front of the vaginal wall
    • Uterus – This occurs when the uterus (womb) drops into the vagina and is classified as follows:
      1. Grade 1 – The uterus has dropped slightly, may not be noticeable, with no symptoms
      2. Grade 2 – The uterus has dropped further into the vagina and the cervix (neck or tip of the womb) can be seen at or just outside the vaginal opening
      3. Grade 3 – A large portion of the uterus has fallen through the vaginal opening
      4. Grade 4 – The whole uterus has fallen through the vaginal opening (procidentia)
    • Vault prolapse – The vagina collapses in on itself after a hysterectomy (surgical womb removal)
  • A prolapse is caused by the continuous weakening of the supporting tissues of the pelvic organs. This weakening may be caused by:

    • Chronic cough or strain from constipation
    • Collagen deficiency
    • Congenital (present at birth) weakness of the pelvic floor muscles, ligaments and fascia
    • Menopause – The supporting tissues become weaker with age and menopause
    • Obesity, large fibroid (fibrous growth), tumour or previous pelvic surgery
    • Pregnancy and childbirth, especially after a difficult and prolonged labour
    • Strenuous physical work or heavy lifting
    • A dragging sensation in the lower abdomen and pelvis
    • A swelling sensation in the vagina or a lump outside the vagina
    • Backache that progresses through the day
    • Difficulty in or inability to have sex – this may cause anxiety or depression
    • Difficulty in passing urine or stools
    • Difficulty in walking or sitting
    • Vaginal bleeding and discharge (not part of the menstrual cycle)
  • Non-surgical treatments are used when the prolapse is mild, and surgery is not needed. Options include pelvic floor exercises to strengthen your pelvic muscles or a pessary (a removable device) placed inside your vagina to hold the prolapsed organ in place.

    Surgical treatment may be needed to lift the prolapsed organ(s) back into place:

    • Anterior repair of a cystocoele (bladder prolapse) – also called colporrhaphy
    • Posterior repair of a rectocoele or enterocoele – also called colpoperineorrhaphy
    • Vaginal hysterectomy to remove the uterus (womb) through the vagina and repair of the vagina
    • Vault prolapse surgery to support the vaginal vault
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