Pelvic organ prolapse is bulging of one or more of the pelvic organs into the vagina. These organs are the uterus, vagina, bowel and bladder.
Symptoms may include
- a sensation of a bulge or something coming down or out of the vagina, which sometimes needs to be pushed back
- discomfort during sex
- problems passing urine – such as slow stream, a feeling of not emptying the bladder fully, needing to urinate more often and leaking a small amount of urine when you cough, sneeze or exercise (stress incontinence)
Some women with a pelvic organ prolapse don’t have any symptoms and the condition is only discovered during an internal examination for another reason, such as a cervical screening.
Why does prolapse happen?
Prolapse is caused by weakening of tissues that support the pelvic organs. Although there’s rarely a single cause, the risk of developing pelvic organ prolapse can be increased by:
- your age – prolapse is more common as you get older
- childbirth, particularly if you had a long or difficult labour, or gave birth to multiple babies or a large baby – up to half of all women who have had children are affected by some degree of prolapse
- changes caused by the menopause – such as weakening of tissue and low levels of the hormone oestrogen
- being overweight, obese or having large fibroids (non-cancerous tumours in or around the womb) or pelvic cysts – which creates extra pressure in the pelvic area
- previous pelvic surgery – such as a hysterectomy or bladder repair
- repeated heavy lifting and manual work
- long-term coughing or sneezing – for example, if you smoke, have a lung condition or allergy
- excessive straining when going to the toilet because of long-term constipation
An anterior prolapse is where your bladder drops down, causing a bulge in the wall of your vagina. It is the result of weaknesses in the support tissue between your bladder and vagina.
When experiencing an anterior prolapse, you may feel the sensation of ‘something coming down.’ You may also feel like you need to pass urine more regularly and feel like the bladder isn’t fully emptied when you visit the toilet. An anterior prolapse is most often caused by childbirth, though it can occur in women who have never been pregnant. A prolapse can cause notable discomfort when having sex and make it difficult for women to keep tampons in. It is possible for women to experience multiple prolapses at any one time, for instance, a prolapse of the support tissues in the womb or the back passage.
An anterior repair is a major procedure, typically recommended after other treatments have been tested and failed. The desired results from surgery are a bladder that is better supported, and no bulge in the vagina.
The aim of this procedure is to tighten the bladder’s support tissue in order to remove the vagina bulge.
If you have experienced a minor prolapse, your doctor may first recommend simple treatments such as pelvic-floor exercises or inserting a pessary into your vagina. If these prove ineffective, your consultant is likely to suggest an anterior repair.
An anterior repair is typically carried out under general anaesthetic and takes approximately half an hour. During the procedure, your consultant will make a small cut on the front wall of your vagina to enable them to push your bladder and urethra back into their correct position. To help support your bladder and urethra they will then stitch the support tissues together. A small part of your vagina wall will be cut away in order to remove any leftover tissue.