How to talk to your doctor about pelvic organ prolapse

Get help early for prolapse

Many women experiencing a prolapse suffer in silence. Amy Steventon, a pelvic health physiotherapist, says often women are too busy or embarrassed to seek help, or worried they’ll need surgery. Some, she adds, assume it’s a “normal” part of ageing. It’s not – and it’s very treatable.

Ms Steventon, who works at the Jean Hailes Clinic, says it’s important to get help early. “The sooner you see your doctor or a pelvic health physio, the sooner you can … alter your lifestyle so your prolapse doesn’t continue to progress.”

“If prolapses are detected early, they can usually be managed well without surgery.”

Dr Judith Hammond, a women’s health GP at the Jean Hailes Clinic, recommends dedicating your whole appointment to prolapse. “Don’t put it on the end of your list [of things to talk about],” she says. Otherwise, there won’t be enough time to properly address it.

There are different types and causes of pelvic organ prolapse – and different treatments. It can be overwhelming. Ms Steventon recommends asking for written information about your prolapse so you can read it after your appointment.

Find a health professional you feel comfortable with

A doctor or pelvic floor physiotherapist can help with prolapse – or you may need to see both. For more severe prolapse, your doctor may also refer you to a specialist, such as a urogynaecologist.

If prolapse feels too personal to talk about, remember you don’t have to see just anyone. Dr Hammond says it’s “about finding [a person] that you trust”.

If you’re looking for a GP, you can book some unrelated health appointments first – “just to get a feel for that doctor”, she says.

Most prolapse symptoms are not an emergency, but some need immediate attention. If you have unusual bleeding or severe pain or cannot wee or poo, see a doctor straight away.

If you’re a new mum, you can even ask about prolapse at your baby’s appointment. “You might say, ‘I’ve noticed that I’m getting some discomfort around my vagina’ or ‘I’m having a bit of trouble with my bladder – is that something I should come and talk to you about?’” says Dr Hammond. “The doctor hopefully will say, ‘Yes, come back [another day] and talk to me.’”

Expect to answer some questions

Your doctor or physiotherapist will want to understand what’s going on. Depending on your situation, Dr Hammond and Ms Steventon say they may ask:

• What’s bothering you? Have you noticed pressure, fullness, heaviness, dragging, bulging or swelling in your vagina?
• Do you have trouble emptying or controlling your bladder or bowel, or do you need to go urgently?
• Do you experience constipation or need to strain when going to the toilet?
• Do you do a lot of heavy lifting – at work, at home or in the gym, for example?
• Do you have pain or discomfort during sex?
• Would you like to talk about using vaginal estrogen? (If you have reached menopause, vaginal estrogen may help strengthen the walls of your vagina and your pelvic floor muscles.)
• When do you notice the problem – at certain times of day or after certain activities?
• Do you cough or sneeze a lot?
• Is your cervical screening up to date?
• Do you have any unusual bleeding?

Know that a physical examination is needed for prolapse

To diagnose a prolapse and recommend the best treatment, your doctor or physiotherapist will need to examine you.

If the prolapse is severe, they’ll be able to see it at the vaginal entrance. If it’s mild or doesn’t bulge out of the vagina, you’ll need an internal examination.

Ms Steventon says: “You will be asked to cough or bear down so the extent of the prolapse can be seen. A speculum [medical tool] may be used to determine the type of prolapse.”

For some people, these examinations can be uncomfortable or distressing. Remember, they can only be done with your informed consent. You can share any concerns beforehand and bring a support person. Also, “you can ask for the examination to be stopped at any time”, adds Ms Steventon.

Once your doctor or physiotherapist knows what type of prolapse you have and how it’s impacting you, you can talk through your treatment options together. Learn more about pelvic organ prolapse.