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Pelvic organ prolapse What is prolapse? Pelvic organ prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of prolapse in later life, but because many women don't seek help from their doctor the actual number of women affected by prolapse is unknown. This leaflet explains the different types of prolapse that can occur and provides information about causes, diagnosis, treatment options and prevention as well as what you can do to help ease your symptoms. Prolapse may also be called uterine prolapse, genital prolapse, uterovaginal prolapse, pelvic relaxation, pelvic floor dysfunction, urogenital prolapse or vaginal wall prolapse. Types of prolapse
There are a number of different types of prolapse that can occur in a woman's pelvic area and these are divided into three categories according to the part of the vagina they affect: front wall, back wall or top of the vagina. It is not uncommon to have more than one type of prolapse. Prolapse of the anterior (front) vaginal wall
When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall. It's common for both the bladder and the urethra (see below) to prolapse together. This is called a cystourethrocele and is the most common type of prolapse in women. Urethrocele (prolapse of the urethra) When the urethra (the tube that carries urine from the bladder) slips out of place, it also pushes against the front of the vaginal wall, but lower down, near the opening of the vagina. This usually happens together with a cystocele (see above).
Enterocele (prolapse of the small bowel) Part of the small intestine that lies just behind the uterus (in a space called the pouch of Douglas) may slip down between the rectum and the back wall of the vagina. This often occurs at the same time as a rectocele or uterine prolapse (see below). Rectocele (prolapse of the rectum or large bowel) This occurs when the end of the large bowel (rectum) loses support and bulges into the back wall of the vagina. It is different from a rectal prolapse (when the rectum falls out of the anus).
Uterine prolapse
Grade 1: the uterus has dropped slightly. At this stage many women may not be aware they have a prolapse. It may not cause any symptoms and is usually diagnosed as a result of an examination for a separate health issue. Grade 2: the uterus has dropped further into the vagina and the cervix (neck or tip of the womb) can be seen outside the vaginal opening. Grade 3: most of the uterus has fallen through the vaginal opening. This is the most severe form of uterine prolapse and is also called procidentia. Vaginal vault prolapse
Describing the severity of a prolapse Most women, and their doctors, describe the severity of a prolapse simply as mild, moderate or severe. There is, however, a grading system that uses numbers to describe the extent of a prolapse. In the past, the grading system for uterine prolapse (1, 2, 3) was also used for other types of prolapse. This wasn't technically accurate, and a new, more precise classification system has recently been developed. The new grading system uses a series of measurements and is fairly complicated, but generally categorises the severity of prolapse into stages I, II, III or IV. Stage I is mild prolapse. Stage IV is severe prolapse. Some doctors may still refer to prolapse using the older classification of 1, 2 and 3. Causes of uterine and bladder prolapse Risk factors Normally, the pelvic organs are held in place by the pelvic floor muscles and supporting ligaments, but when the pelvic floor becomes stretched or weakened, they may become too slack to hold the organs in place. A number of different factors contribute to the weakening of pelvic muscles over time, but the two most significant factors are thought to be pregnancy and ageing. Pregnancy and childbirth Pregnancy is believed to be the main cause of pelvic organ prolapse — whether the prolapse occurs immediately after pregnancy or 30 years later. The weight of the baby, and the physical trauma of labour and birth, stresses and strains the pelvic muscles and ligaments. Some of the tissues that become damaged during pregnancy never fully regain their strength and elasticity. Certain situations in pregnancy and birth further increase the likelihood and extent of damage, such as a large baby, a long labour and the use of forceps or extraction devices. There is conflicting information about the effect an episiotomy (a cut made in the base of the vagina during childbirth) may have on a woman's risk of prolapse, but the most recent research suggests it does not prevent pelvic floor damage. Women who have more than one child, whether the delivery is vaginal or by caesarean section, have a higher risk of prolapse than women who have one child or no children at all. Some people believe a caesarean section may be less damaging than a vaginal birth, but the majority of studies suggest that it is only slightly, if at all, protective. Studies also suggest that women who have children in close succession are at an even greater risk of prolapse because the muscles and ligaments are under constant strain. Ageing and the menopause Our muscles weaken as we grow older and the pelvic muscles are no exception. Although tissue damage is likely to have been caused much earlier, the ageing process further weakens the pelvic muscles, and the natural reduction in oestrogen at the menopause also causes muscles to become less elastic. Obesity, large fibroids or tumours Women who are severely overweight, or have large fibroids or pelvic tumours, are at an increased risk of prolapse due to the extra pressure this creates in their abdominal area. Chronic coughing or strain Chronic (long-term) coughing, from smoking, asthma or bronchitis for example, or the straining associated with constipation, increases a woman's risk of prolapse. A few bouts of bronchitis or constipation are unlikely to have a serious effect on your pelvic muscles, but if the stress and strain is ongoing, it may eventually weaken the pelvic support structures. Heavy lifting Heavy lifting can also strain and damage pelvic muscles and women in careers that involve regular manual labour or lifting, such as nursing, have an increased risk of prolapse. Genetic conditions Women with a genetic collagen deficiency (Marfan or Ehlers-Danlos syndrome) have an increased risk of prolapse even if they don't have any of the other risk factors. Collagen is a natural protein that helps keep tissues plump and elastic. Without it, the pelvic floor muscles become weak. Previous pelvic surgery Pelvic surgery, including hysterectomy or bladder repair procedures, may damage nerves and tissues in the pelvic area increasing a woman's risk of prolapse. Spinal cord conditions and injury Spinal cord injury and conditions such as muscular dystrophy and multiple sclerosis dramatically increase a woman's risk of prolapse. If the pelvic muscles are paralysed or movement is restricted, the muscles waste away and cannot support the pelvic organs. Ethnicity Studies show that white and Hispanic women have the highest rate of pelvic organ prolapse, followed by Asian and black women. There is little information about the incidence of prolapse in women of other (or more specific) ethnic groups.
Women with mild prolapse may have no symptoms or discomfort at all and may not be aware they have a prolapse. When symptoms do occur, however, they tend to be related to the organ that has prolapsed. A bladder or urethra prolapse may cause incontinence (leaking urine), frequent or urgent need to urinate or difficulty urinating. A prolapse of the small or large bowel (rectum) may cause constipation or difficulty defecating. Some women may need to insert a finger in their vagina and push the bowel back into place in order to empty their bowels. Women with uterine prolapse may feel a dragging or heaviness in their pelvic area, often described as feeling 'like my insides are falling out'. With severe prolapse, when the uterus is bulging out of the vagina, the skin may become irritated, raw and infected. Symptoms that may be occur with all types of prolapse:
Diagnosis If you have any of the symptoms of prolapse, particularly if you can see or feel something near or at the opening of your vagina, make an appointment to see your GP. Many women with prolapse avoid going to the doctor because they are embarrassed or afraid of what the doctor might find, but prolapse is very common and is nothing to be ashamed of. Before you see your doctor, it may help to make a list of symptoms, concerns and questions. Take the list with you to your appointment. It may be difficult at first to talk about your symptoms, and some women find the examination uncomfortable, but it only takes a few minutes and, by having your symptoms checked, you are taking an active role in your health and well-being. What to expect at your appointment To look for signs of prolapse your doctor will need to do a thorough pelvic examination. If you prefer this to be done by a female doctor, ask for this when you make your appointment. You will be asked to undress from the waist down and lie on your back on the examination table. You should be given a blanket or sheet to put over yourself but if you aren't, just ask for one. The doctor will ask you to bend your knees and let them fall open. Some women find this position difficult, so if you can't lie this way, say so. The doctor can do the examination with you lying on your side with your knees drawn up in the foetal position. In fact, many doctors will do this anyway when looking for prolapse as it's a good way to check the front and back walls of the vagina. The doctor will feel for any unusual lumps or bumps in your pelvic area by inserting two fingers in your vagina and pushing gently on your abdomen. You will be asked if you feel any pain or discomfort. Tell the doctor if it hurts even if you are not asked. The doctor may also insert a special speculum (called a Sims speculum) to examine the walls of the vagina for bulges. You may be asked to cough or strain during the examination. This enables the doctor to see if any urine leaks or if any of the pelvic organs prolapse into the vaginal walls. Some prolapse symptoms go away when you're lying down, so your doctor may also want to examine you while you're standing. If you have bowel symptoms the doctor may need to feel for bowel prolapse by placing one finger in your rectum and another in your vagina and asking you to strain or bear down. If you have urinary symptoms, the doctor should take a urine sample to check for a urinary infection. A good doctor will explain what s/he is doing throughout the examination but if you have any questions, ask for an explanation. If you have a mild prolapse that isn't causing you any pain or discomfort, you don't need treatment. There are, however, some steps you can take to help improve your prolapse and prevent it from getting any worse, see Preventing Prolapse. If you develop any new symptoms or your existing symptoms get worse, contact your doctor. Because symptoms often develop gradually it may be difficult to judge when you should go back to the doctor. There's no right or wrong answer, but as a general guideline, tell your doctor if:
If your prolapse is moderate or severe and is causing pain or discomfort, you should be referred to a gynaecologist or urologist for further investigations and possible treatment. The specialist will ask you about your symptoms and health history and will examine you again to make sure the diagnosis is as precise as possible. If you have bladder symptoms the specialist may do additional urine and bladder tests to check if the symptoms are related to your prolapse or separate from it. Incontinence will need to be treated in addition to treating your prolapse. Living with pelvic organ prolapse What you can do Living with prolapse can be a challenge, both physically and emotionally, as the symptoms can disrupt day-to-day life. Below are a few suggestions that may make living with a prolapse a little easier. Avoid standing for long periods of time. Many women find their symptoms get worse when they stand and improve when they lie down. Try to schedule in time to put your feet up. You could use the time to read, make to-do lists, write letters, talk with friends or just relax. Do pelvic floor exercises. These help prevent prolapse but can also help strengthen weakened muscles, aid recovery after surgical treatment and may help reduce symptoms such as leaking urine and back pain. See Pelvic floor exercises. Prevent or correct constipation. Eat a high fibre diet (fresh fruits, vegetables, bran) to help prevent constipation and reduce straining. Wear a girdle. Some women find that wearing a tight girdle helps to reduce the heavy, dragging feeling in their pelvic area. Try yoga. Some women find yoga relieves some of the symptoms of prolapse, and it's a good (and gentle) way to stay fit. There are different types of yoga so find a class or group that suits you. Wear a pantyliner or incontinence pad. If you occasionally leak very small amounts of urine you could use odour-control pantyliners, but if you leak more, or frequently, you should use incontinence pads. They come in a range of sizes and are better suited to leaking urine than sanitary towels. If you notice the leaking is getting worse, contact your doctor. Your doctor may want to do some tests but may also be able to arrange for you to get incontinence pads through a district or incontinence nurse. Explore alternatives to sexual intercourse. Moderate to severe prolapse may make sexual intercourse painful or uncomfortable, but there are many other ways to be sexually active, whether on your own or with your partner. Approach this as an opportunity to focus on new ways of finding sexual pleasure. See Resources. Carry wet wipes. If you have bladder or bowel symptoms, use wet wipes to keep yourself clean as well as reduce odour. There are different types available at the shops, in a variety of fragrances, and in large or small packs that fit in your handbag. Clean gently around your genitals and don't use wipes with alcohol or harsh chemicals that may irritate the delicate skin in this area. Treatments There are a number of options available to treat prolapse, including physiotherapy, vaginal pessaries, and a range of surgical procedures. The choice of treatment depends on a variety of factors such as the type of prolapse you have, the severity of your symptoms, your age and other health issues, whether or not you want to have children in the future, and your personal preference. Before you decide on a treatment, talk to your doctor about the risks, benefits and success rates of the treatments you are considering. It may also help to talk with other women who have or have had prolapse. Keep in mind that every woman's situation is unique, and what is right for one woman may not be right for you. Pelvic organ prolapse — Non-surgical treatments There are a number of surgical and non-surgical options available to treat prolapse. The choice of treatment depends on a variety of factors such as the type of prolapse you have, the severity of your symptoms, your age and other health issues, whether or not you want to have children in the future, and your personal preference. Before you decide on a treatment, talk to your doctor about the risks, benefits and success rates of the treatments you are considering. This section describes the non-surgical treatments available for prolapse. Physiotherapy If your prolapse is mild to moderate, you may be referred to a physiotherapist for treatment. A physiotherapist will work with you to create an individualised treatment plan based on pelvic floor exercises (see pelvic floor exercises). These exercises, also called Kegel exercises, may help keep the prolapse from getting worse and may help reduce backache, pelvic pain and incontinence. It may take a few months before you notice any improvement. If you're unsure whether you're doing the exercises correctly, a physiotherapist may be able to help, either through coaching or by using a biofeedback machine. Hormone Replacement Therapy (HRT) Women with prolapse who are experiencing, or are past, the menopause may benefit from HRT, either as a treatment on its own (for mild prolapse) or together with another treatment (for more advanced prolapse). Hormone replacement therapy may help strengthen the vaginal walls and pelvic floor muscles by increasing the oestrogen and collagen levels in your body, but there is little evidence as to whether it is effective in treating prolapse. Before you make a decision about whether or not to use HRT, discuss the risks and benefits with your doctor. Vaginal Pessaries A vaginal pessary is a small device, similar to a diaphragm or cervical cap, which is inserted into the vagina to hold the prolapsed organ(s) in place. Pessaries are made of latex or silicone and come in many different shapes and sizes. Ring pessaries are the most common, but may not be right for every woman.
Pessaries need to be individually fitted and you may need to try a few different shapes and sizes before you find one that feels comfortable and stays in place. Your doctor should have a variety of pessaries for you to try. During your fitting, your doctor will insert the pessary and ask you to walk around, sit, squat, cough and strain to test if it's comfortable and remains in place. If you feel uncomfortable doing this in front of your doctor, ask for a minute or two of privacy while you test the pessary's staying power. Tell the doctor if it doesn't feel right, even if it's the second, third or fourth pessary you've tried. Once you've found the best fit, you will be asked to try it for a month or two before returning for a follow-up appointment. If you have any difficulties or concerns during this period, contact your doctor for an earlier appointment. If your pessary is not working or is causing problems, you can either try a different pessary or a different treatment option entirely. If the pessary is relieving your symptoms and you're not having difficulties with it, you'll be scheduled for follow-up visits every 3 to 6 months. At your follow-ups the doctor will remove the pessary, check whether it's causing any internal problems and whether your prolapse is getting worse, and will insert a new pessary. Follow-up visits are also a good opportunity for you to talk to your doctor about any changes you've noticed or concerns you may have. If your pessary becomes less effective at relieving symptoms you may need to be fitted with a different type or size. This is common. If you have any difficulties with the pessary or if you have any unusual discharge, bleeding or pain, contact your doctor immediately — do not wait for your next appointment. Inserting, removing and cleaning your pessary Recommendations about how often a pessary should be removed range from once a week (for an overnight period) to once every three months or more. In the UK, standard practice is for pessaries to be inserted and removed by your doctor or nurse every 3 to 6 months. But in the USA, women are advised to remove, clean and reinsert their own pessaries more regularly. If you would like to have the option of removing and inserting your own pessary between your scheduled follow-up visits, talk to your doctor about it. She or he may be able to teach you how to insert the pessary yourself. It will probably take a bit of practice to get used to placing it correctly and while some women may be comfortable with this, others may find it too difficult or too much of a nuisance. Double pessaries for severe prolapse Women with severe prolapse who don't want or are advised against surgery may be able to use two ring pessaries together. The double-ring technique is new but an initial study shows it relieves symptoms of severe prolapse, with the exception of rectocele and enterocele. Things to consider before deciding to use a pessary
Some women experience a bad-smelling discharge when they use a pessary. If this happens, contact your doctor, as the pessary may be causing an infection. If a pessary doesn't fit right or is left in place for too long it can irritate the vaginal walls and cause raw, open sores (ulcers). If this happens, the pessary should be removed and oestrogen cream applied to the vagina until the sores have healed. Some people are allergic to latex or develop allergies after using latex products. Tell your doctor if you think you have a latex allergy. If you have any difficulties with your pessary, or have any unusual bleeding or pain, contact your doctor. Pelvic organ prolapse — Surgical treatments Most of the surgical treatments for prolapse aim to lift the prolapsed organ(s) back into place. Hysterectomy (for uterine prolapse) is the only treatment that removes the prolapsed organ altogether. The choice of surgery depends on the type of prolapse you have, your health, age, whether you want to keep your uterus or have children in the future, whether you are sexually active, the skills of your surgeon and your personal preference. If you're not happy with the surgery that has been recommended, talk with your doctor about your concerns. If you are still not satisfied, or would like a second opinion, ask to be referred to another specialist. Questions to ask your doctor about your surgical treatment options:
Diagnosis — before your operation, you and your doctor should be confident that your diagnosis is accurate. It's very common to have more than one type of prolapse at the same time and each one should be taken into consideration when planning treatment. Tests — your doctor may give you a series of bladder tests before your operation even if you don't have bladder symptoms. This is because your prolapse may be masking stress incontinence by pushing against your urethra and preventing urine from leaking. Repairing your prolapse may fix one condition but leave you with another - incontinence. If you do have incontinence, it may be treated at the same time as your surgery for prolapse. Oestrogen cream — if you are past the menopause your doctor may suggest you use oestrogen cream temporarily for a month or two before and after your surgery. This helps to strengthen your vaginal and pelvic tissues and may improve the outcome of surgery. Be aware of the possible outcomes — as with all surgery, the degree of success depends on many factors. While surgical treatment may be successful for one woman, it may have very disappointing results for another. The surgical treatments listed below may repair your prolapse, but they may not relieve all your symptoms, and in some cases, they may make symptoms worse or cause other problems. Statistics show that about one in three women who have a surgical repair go on to have additional surgery. Treating prolapse of the bladder and urethra Anterior Repair (colporrhaphy) This procedure is used to treat prolapse of the bladder (cystocele), urethra (urethrocele) or both the bladder and urethra (cystourethrocele). The operation is done through the vagina and you will be given a general anaesthetic. It involves making a cut in the front (anterior) wall of the vagina so the bladder and/or urethra can be pushed back into place. Once this is done, the surgeon stitches together existing tissues to provide a new support for the bladder and urethra. A small portion of the vaginal wall is removed to give the vagina more strength. The main complications of anterior repair are painful sex (dyspareunia) and incontinence. Your surgeon may be able to reduce the risk of painful sex by making sure the vagina is not narrowed too much or pulled out of place during the repair. Incontinence can usually be prevented when diagnosed before surgery (see Before Surgery, above). Repair with mesh If you've had recurrent prolapse and this is not your first repair operation, mesh (synthetic or animal-based) may be used to help support the vaginal wall and keep the prolapsed organ(s) in place. This may provide better long-term support, but may also cause additional complications such as inflammation or erosion of surrounding tissues and an increased risk of painful sex. Treating prolapse of the small bowel and rectum Posterior Repair (colporrhaphy/colpoperineorraphy) Posterior repair is used to treat prolapse of the rectum (rectocele) and small bowel (enterocele). The operation is done through the vagina and you will be given a general anaesthetic. The procedure is similar to an anterior repair (above) but the doctor may first make a small cut from the base of the vagina towards the anus (similar to an episiotomy during childbirth). This makes it easier for the repair to be done. A cut is then made in the back (posterior) wall of the vagina and the rectum and/or small bowel is pushed back into place. The doctor stitches together the existing tissues to create a new support for the prolapsed organ(s) and then removes some of the tissue from the vaginal wall to make it stronger. If a cut was made at the base of your vagina, it will also be stitched back together. The main complication of posterior repair is painful sex (dyspareunia). Your surgeon may be able to reduce the risk of painful sex by not narrowing the vagina too much or pulling it out of place during the repair, but there is a high risk of experiencing painful sex after this procedure. Repair with mesh If this is not your first surgical repair, your doctor may use synthetic or animal-based mesh to help strengthen the vaginal wall and hold the prolapsed organ(s) in place. While the use of mesh tends to provide long-lasting support, it may also cause surrounding tissues to become inflamed or eroded, and studies suggest it may increase the risk of painful sex. Treating Uterine Prolapse There are two surgical approaches to treating a uterine prolapse: removing the uterus altogether (hysterectomy) or lifting it and holding it in place (suspension). Removing the Uterus Hysterectomy Hysterectomy (removal of the womb) is considered to be the most effective treatment for uterine prolapse. Despite this, it still may not relieve all of your symptoms and may lead to other health issues (see below). A hysterectomy for prolapse is usually done through the vagina, but if your uterus is very large it may need to be removed abdominally. The procedure is done under general anaesthetic and involves cutting the ligaments that hold the uterus in place, removing the uterus, closing off the top of the vagina and then shortening and reattaching the ligaments to hold the vagina up. Hysterectomy is a major operation and after having this surgery:
If you are unsure about whether to have a hysterectomy, take as much time as you need to make your decision. You may also want to get a second opinion about your treatment options. For more information about hysterectomy, see our online hysterectomy booklet. Suspending the Uterus Treatments that suspend rather than remove the uterus are recommended for women who want to keep their uterus or have children in the future. Procedures can be done either vaginally or abdominally, and there is some evidence to suggest that abdominal repairs tend to have better long-term results. Sacrohysteropexy
There are few complications associated with sacrohysteropexy but there is a risk that the mesh may wear away (erode) the surrounding tissues or cause an inflammation. In severe cases, the mesh may need to be removed. If you are planning to have children after the procedure, a pregnancy may damage the repairs and cause the prolapse to recur. To help prevent this, you may be advised to have a scheduled caesarean section rather than a vaginal birth. Sacrospinous fixation This operation holds the uterus up by stitching it to one of the pelvic ligaments (called the sacrospinous ligament) using sutures only; no mesh. The procedure is done vaginally and is therefore less invasive than sacrohysteropexy, but also has lower success rates. While complications are rare, there is a risk of damage to the pudendal and sciatic nerves that can lead to severe pain in your legs, buttocks, genitals and pelvic area. Manchester repair Manchester repair (also called Fothergill operation) is no longer commonly performed, but used to be the only surgical alternative to hysterectomy for treating uterine prolapse. The procedure is done vaginally and involves removing part of the cervix (which may be elongated) and pushing the uterus back into place by shortening the ligaments that support it. The operation has a high failure rate and many women require additional surgery, usually a hysterectomy. In addition, the entrance to the uterus may become either very narrow or very relaxed and this can cause problems during pregnancy and childbirth. Treating Vaginal Vault Prolapse Sacrocolpopexy
Complications are uncommon but there is a risk that the mesh may inflame or erode the tissue around it. If this is severe, the mesh will need to be removed. This is considered a major procedure and therefore may not be appropriate for women who are frail or in poor health. Sacrospinous Fixation This operation supports the vagina by attaching the vaginal vault to one of the ligaments in the pelvic area (the sacrospinous ligament). The procedure is done through the vagina and uses sutures only; no mesh.
Complications are rare, but can include damage to the pudendal and sciatic nerves, causing severe pain in your legs, buttocks, genitals and pelvic area. Note: Following surgery you may have mild to moderate pain in your buttocks and down one thigh. This is normal but should get better within a month. If the pain does not go away or get better, tell your doctor. Tight (anterior and posterior) repair This procedure is rarely done. It involves removing a large amount of the vaginal tissue in order to tighten and support the vagina. The main complication of this operation is severe pain. Colpocleisis (colpectomy or Le Forts procedure) Colpocleisis — vaginal closure — is another procedure that is rarely done. It closes off the vagina by stitching the front and back walls together, leaving two pencil-width channels on either side. The operation is performed vaginally and can be done using a local anaesthetic or epidural. It is only offered as a treatment option for women who have severe prolapse, are too frail to undergo any other surgical treatment and are absolutely certain they don't ever want to have sexual intercourse again. Once the vagina is sewn up, penetrative sex is no longer possible, and a vault prolapse may still recur, falling through what remains of the vagina. Pelvic organ prolapse — Recovering from surgery Most repair operations take about one hour, but you'll need to stay in hospital for a few days. If the surgery is done vaginally, the area around your vagina will be tender and bruised. If you have a posterior (back) vaginal repair (for enterocele or rectocele), you may also have a few stitches at the base of your vagina. If your surgery is done abdominally, you'll have a few stitches in your belly and it will be quite sore. To help ease the pain you'll be given pain medication in tablets or injections and you may be given a device that lets you control the amount of pain medication you have. You will also have a drip in your arm to give you fluids. You may have a catheter (a tube to remove urine) in place but this will probably be removed within a day or two. Your catheter may be attached through a cut in your abdomen even if you've had a vaginal procedure. Some women find it difficult to pass urine for a few days after the operation but this should improve gradually. It's important to start moving as soon as possible after the operation. You'll feel drowsy from the general anaesthetic, but start by lifting your head off the pillow, pointing and flexing your toes and sitting up for short periods. You may be seen by a physiotherapist, who will show you some exercises and teach you how to get out of bed and move around without hurting yourself, but if not, ask the nurse for help or ask to be referred to a physiotherapist. Getting better at home It will take about three months before you're fully recovered, but you may feel better after about six weeks. It's important to take it easy, even if you feel energetic, as your internal wounds will still be healing. Rest — get as much rest as possible and do not lift anything heavy (children, laundry, shopping bags, pets etc) for at least three months as this may damage the repair. Don't do any strenuous exercise (walking is fine) for about six weeks and try to take as much time as possible off work (including housework). If you live alone, try to arrange for someone to help with the cleaning and shopping for a few weeks after your surgery. Vaginal discharge — you may have a slight vaginal discharge for about six weeks. Some women notice threads in the discharge when the internal stitches dissolve. This is normal. Do not use tampons for about six weeks while your vagina is healing. Contact the doctor if the discharge gets worse rather than better or if you have any unusual bleeding or pain. Sex — Don't have sexual intercourse for six weeks or until the vaginal discharge has stopped. If you're unsure about when it's safe to have sex again, contact your doctor. Preventing pelvic organ prolapse There are a number of things you can do to reduce your risk of prolapse or help prevent a mild prolapse form getting worse:
Pelvic Floor Exercises (Kegel Exercises)
Start by locating the muscles you need to exercise. There are a few different ways to do this:
Set 1 —lowly tighten your pelvic floor muscles and count to four, then let the muscles relax for a count of four. As your muscles get stronger gradually increase the count to 10. Try to repeat this 10 to 15 times. Check that you're not tightening the muscles in your legs, abdomen or buttocks, as it's important to use only your pelvic muscles. Remember to keep breathing. Set 2 — Now tighten and relax your pelvic muscles as quickly as you can, again 10 to 15 times. As a preventive measure, try to do the exercises two or three times a day. If you have a prolapse, you may be advised to increase the number of times you do the exercises, but don't overdo it. Excessive exercising of the pelvic muscles can cause muscle fatigue and make the exercises less effective. You can do the exercises anywhere, anytime, but studies show that when women do them at home, they are more likely to do them correctly. Some women find it helps to set aside specific times to do the exercises, such as before getting out of bed in the morning and before going to sleep at night. If you think you're doing the exercises incorrectly or need help locating your pelvic floor muscles, a physiotherapist will be able to help you. Ask your doctor for a referral. Pelvic organ prolapse — Resources and links Organisations The Continence Foundation Incontact Books Sex Women's Health Handbook by Dr. Miriam Stoppard (Dorling Kindersley 1999) The Joy of Sex by Alex Comfort; foreword by Claire Rayner (Mitchell Beazley 2002) Surgery Hysterectomy, Vaginal Repair, and Surgery for Stress Incontinence by Sally Haslett, Molly Jennings and Wendy Weatheritt (Beaconsfield Publishers) Websites Women's Diagnostic Cyber |
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Written by Tamara Beus and published in printed format (2003) by Women's Health
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Pelvic organ prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. The womb (uterus) is the only organ that actually falls into the vagina. When the bladder and bowel slip out of place, they push up against the walls of the vagina. While prolapse is not considered a life threatening condition it may cause a great deal of discomfort and distress.
Cystocele (bladder prolapse)
Prolapse of the posterior (back) vaginal wall
Uterine prolapse is when the womb drops down into the vagina. It is the second most common type of prolapse and is classified into three grades depending on how far the womb has fallen.
The vaginal vault is the top of the vagina. It can only fall in on itself after a woman's womb has been removed (hysterectomy). Vault prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.
Pessaries are generally recommended as treatment for women who are waiting for surgery, women who are pregnant or want to have more children in the future, and women who are unable or choose not to have surgery.
Some pessaries may interfere with sexual intercourse. A ring pessary may be left in place during sex — if it's comfortable for you — but other pessaries may literally get in the way. There is no published information about whether pessaries affect other sexual activity (such as oral sex) or a woman's ability to achieve orgasm. You (and your partner) may want to explore what's comfortable and pleasurable for you both. See 
This procedure uses a strip of synthetic mesh to hold the uterus in place. The operation is done abdominally, either through a 15cm cut just above the pubic hairline or through keyhole surgery (laparoscopy). The doctor attaches one end of the mesh to the cervix and top of the vagina and the other to a bone (sacrum or sacral bone) near your spine. Once in place, the mesh supports the uterus.
This procedure uses synthetic mesh to support the top of the vagina. During the operation, the doctor stitches one end of the mesh to the top of the vagina and the other end to a bone near your spine (called the sacrum or sacral bone). It is done abdominally, either through keyhole surgery (laparoscopy) or a larger cut just above the bikini line. Sacrocolpopexy has a higher success rate than sacrospinous fixation (below).
Pelvic floor exercises help prevent prolapse by strengthening the muscles that support the pelvic organs. The exercises are easy and quick to do, but it's important to do them correctly, and many women benefit from guidance from a physiotherapist.