There are many different types of prolapse, including uterine, bladder and bowel prolapse.
Causes of prolapse, symptoms, tests used to diagnose prolapse, and management and treatment of prolapse are discussed.
Prolapse is caused by a stretching of the ligaments and muscles that support the pelvic organs, causing those organs to drop down. The word prolapse literally means to 'fall out of place'.
There are different types of prolapse, including:
| Types of prolapse | What happens |
|---|---|
| Vaginal prolapse | The walls of the vagina become overstretched and bulge downwards towards the vaginal entrance. The bulging can be:
|
| Uterine prolapse | The uterus (womb) and cervix (opening to the womb) drop down towards the vaginal entrance and may protrude outside the vagina. |
| Bladder prolapse (also called cystocele) | The bladder causes a bulge in the vaginal wall. A cystocele usually occurs because of a weakening of the pelvic floor muscles, which support the uterus, bladder and bowel. A cystocele can occur by itself or it may happen along with other abnormalities, such as a rectocele (see below) or uterine prolapse. |
| Bowel prolapse (also called rectocele) | When the bowel bulges forward into the back vaginal wall. |
A prolapse can result from anything that puts pressure on the pelvic floor, such as:
Women who have had pelvic surgery may also be at increased risk of prolapse.
Postmenopausal women are more susceptible to prolapse. The trigger is a loss of oestrogen during menopause. This hormone helps to keep the pelvic floor muscles, which support the vagina and bladder, well toned. Once oestrogen levels drop after menopause, these muscles become thinner, weaker and less elastic. The vaginal skin may also stretch, which may allow the bladder or bowel to bulge into the vagina.
The symptoms of a prolapse depend on individual factors, such as the severity of the prolapse and level of physical activity.
The symptoms can include:
In severe cases, the vaginal wall or cervix may protrude outside the vaginal entrance.
A prolapse is diagnosed by a medical history check and a physical examination. The physical examination will determine:
Tests that may be done include:
| Test | What it assesses |
|---|---|
| Pelvic ultrasound | Whether there are any masses or cysts in the pelvic area. |
| Urodynamics: a test of bladder function | Different types of incontinence, particularly stress or urge incontinence. |
| Bladder ultrasound | Residual urine (urine left in the bladder after passing urine). |
| Mid-stream urine test | Rules out infection if there are bladder symptoms. |
Gynaecologists with a special interest in prolapse use a grading system called the POP-Q system to measure the degree of prolapse in centimetres.
A prolapse is graded by how much the organ or vaginal wall is pushing down into the vagina. The three stages are:
| Stage | What happens |
|---|---|
| Stage 1 | The wall/organ protrudes a little way into the vagina. |
| Stage 2 | The wall/organ protrudes close to the vaginal opening. |
| Stage 3 | The wall/organ protrudes out of the vagina. |
Without intervention, the symptoms of prolapse usually worsen over time. However, there is a lot you can do to improve the symptoms.
Before a prolapse occurs, there may be a slackening in the walls of the vagina, so awareness of this weakening and preventing it from getting worse are vital.
Treatment will depend on the severity of the prolapse and the degree it interferes with a woman's lifestyle. In some women, strengthening the pelvic floor muscles and modifying daily activities may be all that is required.
Being sexually active does not cause or worsen prolapse.
| Level of prolapse | Management and treatment |
|---|---|
| Prevention and mild cases of prolapse | Lifestyle changes and preventive measures such as pelvic floor exercises |
| Moderate cases |
|
| Severe cases |
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| Action | What to do, and why you need to do it |
|---|---|
| Lifting | Avoid lifting heavy objects (more than 10kg) – this includes children and grandchildren! Why? To avoid straining and pushing the prolapse down. |
| Weight range | Keep within a healthy range. Why? Being overweight has been shown to worsen prolapse. |
| Fibre | Eat recommended daily fibre intake of 30g. |
| Fluid | Drink between 6 and 8 glasses of fluid each day. Why? Not drinking enough fluid can make stools hard, dry and difficult to pass, which can cause straining. |
| Toilet habits |
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| Physical activity |
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| Pelvic floor exercises |
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| Seek medical advice | Seek medical advice for any condition that causes coughing and sneezing, such as asthma, chest infections and hay fever. Why? Repetitive sneezing and coughing may cause or worsen cystocele. |
| Medication | Seek a prescription for hormone therapy, such as a cream, pessary or a vaginal tablet. Why? Helps vaginal walls and pelvic floor muscles to offer more support. |
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at August 2018.
