Pelvic Organ Prolapse: Symptoms, Causes and When to See a GP

A heavy, dragging feeling low in the pelvis, or a lump in or around the vagina, can be worrying, and it is not always easy to bring up. Pelvic organ prolapse is one possible reason for symptoms like these. It is a common condition, and there are several ways to manage it, from changes in daily habits to treatment.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse is when your womb, bladder or bowel bulge into the vagina [1]. It happens when the tissue and muscles of the pelvic floor no longer support the pelvic organs, so they drop from their normal position [2]. The bladder is the most commonly involved organ [2].

How Common It Is

Pelvic organ prolapse is common in women over 50, and it can affect anyone with a vagina [1]. The Royal College of Obstetricians and Gynaecologists (RCOG) says it affects 1 in 10 women over the age of 50 years [3].

Symptoms of Pelvic Organ Prolapse

Many women have some degree of prolapse, although not all women have symptoms [2], and mild prolapse often causes no symptoms [3]. Sometimes a prolapse is only found during tests done for another reason, such as cervical screening [1].

Your symptoms will depend on the type and degree of your prolapse [3]. When there are symptoms, they can include:

• a feeling of heaviness, discomfort or pressure in your lower tummy or vagina [1][2]
• backache [3]
• a dragging feeling in the pelvis, which may get worse as the day progresses [3]
• feeling or seeing a bulge or lump inside your vagina, or coming out of it [1][2][4]
• pain, discomfort, numbness or a lack of sensation during sex, and other sexual difficulties [1][2][3]
• feeling anxious about sex [3]
• problems pooing, such as constipation [1]
• incomplete bowel emptying [3]
• problems peeing, such as feeling like your bladder is not emptying fully [1]
• needing to go to the toilet more often [1][3]
• needing to pee urgently [3]
• difficulty passing urine [3]
• frequent bladder infections (cystitis) [3]
• leaking pee, such as a small amount when you cough, sneeze, laugh, exercise or lift heavy objects [1][2][3]

A bulge, dragging, heaviness and backache are often worse if you have been standing for a long time and may improve when you lie down [3]. Some of these symptoms may not be directly related to your prolapse [3].

Causes of Pelvic Organ Prolapse

Pelvic organ prolapse can happen when the pelvic floor muscles weaken [1]. It is more common as you get older, particularly after the menopause [1].

Prolapse can be caused by [1]:

• pregnancy and childbirth
• being overweight
• long-term constipation and straining
• persistent coughing
• pelvic surgery, such as a hysterectomy

Some health conditions can also make a prolapse more likely, including joint hypermobility syndrome, Marfan syndrome and Ehlers-Danlos syndromes [1].

The supporting muscles and tissue of the pelvic floor may become torn or stretched because of labour or childbirth, or may weaken with age [2]. Other risk factors include genetic predisposition and connective tissue disorder [2].

When to See a GP

The UK National Health Service (NHS) gives this non-urgent advice [1]:

See a GP if:

• you have a lump in or around your vagina
• you have any other symptoms of pelvic organ prolapse

The US Food and Drug Administration (FDA) advises [2]:

It is important for women to consult with their health care provider for proper diagnosis of POP.

What Happens at Your Appointment

If you have symptoms that could be caused by a prolapse, a GP will ask about your symptoms and examine you, and you will need to undress from the waist down [1]. A provider may be able to diagnose a pelvic floor disorder with a physical exam [5].

You can let the GP know if you would like someone else in the room with you, called a chaperone, and you can ask for the examination to be done by a female doctor if you prefer [1]. The doctor will feel for any lumps in your pelvic area and inside your vagina, and may gently put a smooth, tube-shaped tool called a speculum into your vagina to see if there is a prolapse [1]. If you have problems with your bladder, the GP may refer you to hospital for further tests [1].

If you feel uncomfortable, anxious or distressed at any time before, during or after an examination, let your healthcare professional know [3]. You can ask them to stop at any time, and you can bring a friend or relative if you wish [3].

Grades of Prolapse

If you are diagnosed with a prolapse, it may be given a number from 1 to 4 depending on how severe it is, with 4 being a severe prolapse [1].

Treatment Options

Treatment depends on which organs have prolapsed and how severely [1]. Your doctor will also consider your age, your overall health and whether you are planning to have children in the future [1]. Your choice of treatment will depend on how the prolapse affects your quality of life [3].

Not everyone with prolapse needs surgery or any other form of treatment [3]. If you do not have any symptoms, or the prolapse is not bothering you, you may not need medical treatment [1]. Prolapse is not life threatening, but it may affect the quality of your life, and your symptoms may stay the same, get worse or sometimes even improve over time [3].

If the prolapse is more severe or your symptoms are affecting your daily life, the choices can include:

• physiotherapy and pelvic floor muscle training, usually with a specialist women's health physiotherapist [1][2][3]
• a vaginal support pessary, a removable device inserted into the vagina to support the pelvic organs [1][2][3]
• surgery to lift and support the pelvic organs, which may be an option if the prolapse is severe [1][3]

You and your doctor will decide together what is the best option for you [1]. Treatment aims to support the pelvic organs and ease your symptoms [3]. Nonsurgical or surgical treatment is usually effective, but it may not completely solve all symptoms [2], and prolapse may return [3].

In the UK, surgery that puts a supportive mesh inside the vagina is no longer done on the NHS, unless there's no alternative [1].

Things You Can Do to Help

Some lifestyle changes you can make yourself may help reduce prolapse symptoms [1][3]. These include:

• maintaining a healthy weight [1][3]
• eating more fibre, drinking plenty of water and doing gentle exercise like walking regularly to avoid constipation [1][3]
• avoiding physical activities that put a lot of strain on the pelvic floor, like heavy lifting, running and trampolining [1][3]
• doing regular pelvic floor exercises [1]
• managing a long-standing cough if you have one [3]
• not smoking, because stopping smoking means you are less likely to have a persistent cough that can put pressure on your pelvic floor [1][3]

Pelvic floor exercises may not get rid of your prolapse but are likely to improve your symptoms [3]. Even if you do not currently have any symptoms, you may wish to consider pelvic floor exercises and lifestyle changes to prevent your prolapse from getting worse [3].

Help and Support

You will be supported by your doctor or specialist, and you may also find it helpful to get support online [1]. The NHS says that in the UK, national charities can offer support and information about prolapse [1]. One of these, Bladder and Bowel UK, offers information and support for anyone affected by bladder or bowel problems [1].

If you are deciding on treatment, you may want to talk over your options with your family or friends [3]. It can help to write a list of the questions you want answered and take it to your appointment [3].

Conclusion

Prolapse can feel like an awkward subject to raise. Noting which symptoms bother you most, and how they change through the day, makes it easier to agree with your doctor on an approach that fits your life.

Medical Disclaimer

This article is for general information and does not replace advice from a qualified health professional. If you think you need urgent medical care, get emergency help straight away.