Pelvic Organ Prolapse
Common. Treatable. And absolutely worth talking about.
Pelvic organ prolapse occurs when one or more of the pelvic organs, the bladder, uterus or bowel, descend from their normal position and press into or beyond the vaginal wall.
It affects up to 75% of women at some point in their lifetime. Yet the majority suffer in silence, either because they don't know what they're experiencing, or because they've been told it's something they just have to live with.
It isn't. And you don't.
Types of prolapse
There are several types of pelvic organ prolapse and many women experience more than one simultaneously.
✦ Anterior wall prolapse (cystocele) — the bladder descends into the front wall of the vagina. The most common type. Symptoms often include bladder pressure, urinary frequency and incomplete emptying.
✦ Posterior wall prolapse (rectocele) — the bowel descends into the back wall of the vagina. Often associated with difficulty emptying the bowel, pressure and a feeling of needing to support the perineum to open the bowels.
✦ Uterine prolapse — the uterus descends into the vaginal canal. Can range from mild to complete prolapse. Associated with heaviness, dragging and pelvic discomfort.
✦ Vault prolapse — occurs following hysterectomy when the top of the vagina descends. Less common but well managed with physiotherapy.
✦ Multi-compartment prolapse — when more than one type occurs simultaneously. More common than most people realise.
Symptoms
Prolapse symptoms vary widely between women, some have significant prolapse with minimal symptoms, others experience significant impact from a mild prolapse. How you feel matters, regardless of the grade.
Common symptoms include:
✦ A feeling of heaviness, fullness or dragging in the vaginal area, particularly after prolonged standing or at the end of the day
✦ A visible or palpable bulge at the vaginal opening
✦ Bladder symptoms — urgency, frequency, leaking or difficulty emptying
✦ Bowel symptoms — difficulty emptying, needing to support the perineum, incomplete emptying
✦ Lower back or pelvic discomfort
✦ Discomfort or reduced sensation during sex
✦ Symptoms that improve after lying down and worsen with prolonged activity
If any of these sound familiar, please don't wait. Early assessment and treatment leads to significantly better outcomes.
Risk factors
While prolapse can affect any woman, certain factors increase the risk:
✦ Pregnancy and vaginal birth — particularly first birth, multiple births, instrumental delivery or large babies
✦ Connective tissue disorders — affecting the integrity of the supporting ligaments
✦ Chronic constipation and straining
✦ Chronic cough or respiratory conditions
✦ Obesity — increasing load on the pelvic floor over time
✦ Repetitive heavy lifting — occupational or recreational
✦ Menopause — oestrogen loss affects the strength and elasticity of pelvic floor tissues
✦ Previous pelvic surgery
Having one or more risk factors does not mean prolapse is inevitable and having prolapse does not mean surgery is the answer. Physiotherapy is an effective first-line treatment for the majority of women.
How we assess and treat
At Fitt Physiotherapy our physiotherapists are trained to assess, diagnose and treat pelvic organ prolapse and to do so in a warm, thorough and dignified way.
Your assessment will include:
✦ A detailed symptom and health history
✦ A clear explanation of the assessment process before we begin
✦ Internal pelvic floor assessment, evaluating prolapse grade, pelvic floor muscle function and coordination
✦ Real-time ultrasound imaging where appropriate
Treatment is individualised and evidence-based. Options may include:
✦ Pelvic floor muscle training — targeted strengthening and coordination to improve support and reduce symptoms
✦ Lifestyle modification — bowel health, fluid intake, weight management and activity modification
✦ Pressure management strategies — learning to protect your pelvic floor during exercise, lifting and daily activities
✦ Vaginal pessary fitting — a supportive device inserted into the vagina to mechanically support prolapsed organs. Our physiotherapists are trained in pessary assessment, fitting and ongoing management
✦ Topical oestrogen — we work collaboratively with your GP or gynaecologist to explore whether topical oestrogen is appropriate to improve tissue quality
✦ Surgical referral — for cases where conservative management has been maximised and symptoms remain significantly limiting, we provide referrals to specialist urogynaecologists
The right treatment is the one that fits your life, your symptoms and your goals. Our role is to work through the options with you, not to make decisions for you.
You don't have to just live with this.
Prolapse is one of the most treatable conditions we see and the sooner it's assessed, the better the outcomes.
We're happy to answer your questions before you book.