What's prolapse?
Our pelvic organs are held in place by a network of supportive muscles and ligaments. Kind of like a hammock, these tissues help bind our organs to the walls of the pelvis, and keep them suspended at where they should be.
But when these supportive tissues get a bit worn out, they can stretch and loosen, causing the bladder, rectum or uterus to drop out of place. When this happens, these organs can sag into the vagina and cause problems with going to the toilet, painful sex, and a range of other uncomfortable sensations.
When pelvic organs drop down out of place, it’s called pelvic organ prolapse. And it’s more common than you might think. In fact, almost 50% of mums who have had vaginal deliveries experience some level of pelvic organ prolapse.
To start with, every woman should get familiar with her body. Every woman’s body is a little bit different, so what’s ‘normal’ for you might not be the same for others.
Getting to know how your body feels, looks, and responds to stimuli is an important part of maintaining your gynaecological health.
What causes pelvic organ prolapse?
Pregnancy and birth are the biggest causes of prolapse, with almost 1 in 2 women experiencing some degree of prolapse somewhere along their baby journey.
During pregnancy, the pelvic floor is weakened by the extra weight of your baby, as well as hormonal changes within your body. Then when you give birth, your pelvic muscles go through a lot of extra pressure and stretching too - particularly if you have a long labour, your baby is big, or you’re having more than one baby.
But childbirth isn’t the only cause of prolapse. Other stresses can also cause your pelvic muscles to wear out, such as:
- Frequent constipation and straining on the toilet.
- Obesity - as the extra weight is constantly being pulled down by gravity.
- A chronic cough such as a smoker’s cough or an asthmatic cough.
- Regular heavy lifting (including shopping bags and children).
Women in menopause are also at higher likelihood of prolapse, as pelvic tissues depend on oestrogen to maintain their strength and tone. So when oestrogen levels drop during menopause, pelvic tissues find it harder to maintain their elasticity. Vaginal skin might also stretch and become thin, allowing the bladder or uterus to bulge into the vagina.
Types of pelvic organ prolapse
The type of prolapse may depend on which weight-bearing or stabilising structures within the pelvis have stretched and loosened.
Prolapse of the rectum (rectocele)
This type of prolapse involves the back wall of the vagina. When this wall weakens, the rectal wall pushes against the vagina, creating a bulge that sticks into the vagina.
Prolapse of the bladder (cystocele)
This can occur when the front wall of the vagina weakens, resulting in the bladder pushing into the vagina. When this occurs, the urethra usually prolapses too, causing urinary stress incontinence.
Prolapse of the uterus
This involves a weakening of the uterosacral ligaments, which causes the uterus to fall downwards.
Prolapse symptoms
Symptoms vary depending on factors that are individual to you, such as the severity of the prolapse, the organs involved (your uterus, bladder, or rectum) and your general health.
Typical symptoms can include:
- General discomfort in your vagina, pelvis, or lower back
- Straining to urinate or empty the bowel
- An inability to completely empty your bladder or bowel on the toilet
- A ‘stop and start’ flow of urine
- Feeling a bulge or swelling inside the vagina
- Bladder or bowel urgency or incontinence
- A heavy sensation or dragging in the vagina
- Constant pressure and a ‘full’ feeling in the vagina
- Painful sex or loss of sensation during intercourse
- Frequent urinary tract infections
These signs can be worse at the end of the day, and you may feel better after lying down.
How is pelvic organ prolapse diagnosed?
Diagnosis of prolapse of the uterus, bladder or rectum begins with a medical history check and physical examination. Your GP will seek to determine how severe the prolapse is, how well your pelvic floor muscles are functioning, and which organs are involved.
A few tests might be ordered to help with this. These include:
Pelvic ultrasound: To determine whether there are any masses or cysts in the pelvic area
Bladder ultrasound: To look for residual urine left in the bladder
Mid-stream urine test: To rule out bladder infection
If you are experiencing uterine prolapse, the condition is described in stages that indicate how far your uterus has descended.
- Stage 1 – the cervix is sitting in the upper half of the vagina
- Stage 2 – the cervix has descended almost to the vaginal opening
- Stage 3 – the cervix protrudes out of the vagina
- Stage 4 – the uterus is completely out of the vagina.
Management and treatment of prolapse
Without intervention, the symptoms of prolapse generally get worse over time. But fortunately, there is a lot you can do to improve your symptoms and get back your quality of life.
Treatment depends on the severity of the prolapse and the degree it interferes with your lifestyle and wellbeing. For some women, small modifications might do the trick. For others, a little more help may be required to get things back to normal.
Surgical prolapse treatment options
If your support tissues and ligaments are torn or stretched beyond the benefits of conservative treatments, surgical intervention may be required. Surgery aims to reinforce the tissues around the organ to restore it to its normal position. There are a few different ways to do this, and your gynaecologist will consult with you to ensure the most suitable approach for you.
Surgery can involve:
Repairing weakened pelvic floor tissues: This is generally approached through the vagina but sometimes through the abdomen as a laparoscopic (keyhole) procedure. During the surgery, your own tissue, donor tissue or synthetic material is grafted onto weakened pelvic floor muscles to help support your organs.
Removal of the uterus (hysterectomy): If you are finished having children, you may decide on a hysterectomy to remove your prolapsed uterus. However, this is a major surgery and therefore reserved for those who haven’t had any significant improvement using non-surgical methods.
Both surgeries can be performed three different ways: abdominal, vaginal or laparoscopic (key-hole). At Northside Gynaecology, we practice single-cut laparoscopy which offers reduced pain and faster recovery times for our patients.
While most typical laparoscopic operations require multiple cuts, with single cut laparoscopy, only one incision is required to carry out the entire operation.
Single cut laparoscopy is not suitable for every woman however. Should you require surgery, your gynaecologist will assess your individual situation and advise on the best path forward.
Non-surgical prolapse treatment options
If the prolapse is mild or in the early stages, there are a range of options that can help:
- Pelvic floor exercises (Kegels) done at home a few times a day, or under the advice of your prolapse specialist
- Making lifestyle modifications to avoid what is causing the prolapse in the first place, such as improving your diet, losing weight, finding alternatives to heavy lifting, and so on.
- Practicing good bowel and bladder habits to avoid straining on the toilet
- Having a small plastic or rubber device fit inside your vagina (a pessary) to provide support for your pelvic organs.
Prevention is better than cure!
Before a prolapse occurs, the walls of your vagina might start slackening, so being aware of weakness or changes in your sexual health is vital for preventing it from getting worse
Some other ways that you can reduce your risk of prolapse include:
- Regularly practicing pelvic floor exercises to support your pelvic organs
- Resisting the urge to strain when using your bowels
- Keeping your weight within a healthy range for your height and age
- Learning safe ways of lifting, including getting help when lifting heavy loads
- Seeing your doctor if you have a cough that won't go away, and
- Visiting your GP or gynaecologist if simple things don't seem to make it better.
Prolapse Specialists Brisbane
If you think you might have a prolapse, don’t be afraid to talk about it! You might feel a little embarrassed or hesitant to draw attention to the problem, but there is no reason to suffer in silence. Your gynaecological health is important - so speak up if something’s not right.
Talk to your doctor about any prolapse symptoms. They will refer you to Northside Gynaecology if further diagnosis and treatment is required.
Our Brisbane specialists are skilled in diagnosing and treating pelvic prolapse. Visit our specialists in Kedron, or North Lakes.
Prolapse surgery is performed at Northwest Private Hospital in Everton Park and Brisbane Private Hospital in Spring Hill.
