Pelvic Organ Prolapse (POP)

Who is the leaflet for?

This leaflet is for women who have or may be at risk of developing a pelvic organ prolapse. The information will help you understand what a prolapse is, how you might be able to make the prolapse less bothersome and prevent it from getting worse. Pelvic organ prolapse is very common, affecting up to half of all women at some point in their lives. A third of all women seek help for the symptoms from their prolapse.

What is pelvic organ prolapse?

A pelvic organ prolapse is a bulge coming into the vagina. It can occur when there is a weakness in the walls of the vagina causing the bladder, bowel or uterus (womb) to protrude. A woman may experience a feeling of heaviness, dragging or a sensation of something coming down. A pelvic organ prolapse can also cause bladder or bowel problems, such as incomplete emptying. It may also interfere with sexual activity. A pelvic organ prolapse can occur when the muscles, ligaments or tissues cannot support everything in the pelvis. Risk factors include childbirth, aging, a family history, repetitive straining on the pelvis such chronic coughing, a history of constipation, being overweight and repetitive heavy lifting. There are different types of pelvic organ prolapse depending on (which organ is coming down) where the weakness occurs.

Types of pelvic organ prolapse

Anterior wall prolapse

This is the most common prolapse. The wall supporting the bladder bulges down into the vagina. This often causes problems with bladder emptying, urgency and needing to go to the toilet more often.

Posterior wall prolapse

The wall supporting the rectum bulges down into the vagina. This often causes problems of not managing to empty your bowel fully, which may make bowel leakage more likely.

Apical prolapse

This is when the uterus/top of the vagina begins to move downwards into the vagina due to the loss of supports keeping the uterus held at the top of the vagina. The cervix then sits lower than it should in the vagina. Even after a hysterectomy, when the uterus has been removed, the top of the vagina can bulge downwards. This may also be called a uterine or vault prolapse.

It is quite common for a pelvic organ prolapse to involve one or more areas of the vagina. You might have a large front wall prolapse with the back wall coming down a bit and the uterus sitting low in the vagina.

Pelvic organ prolapse is not a life threatening condition, and not all prolapses get worse; some may improve.

If you have been told that you have a pelvic organ prolapse you may have the following choices:

• do nothing and wait and see if your symptoms change
• make lifestyle changes and improve the strength of your pelvic floor muscles
• try a vaginal pessary
• try oestrogen cream
• surgery, if the doctor has suggested that it might help

Management

You may choose to do nothing if your prolapse is not bothersome. However new research suggests you can prevent your prolapse getting worse by following the advice below.

Pelvic floor muscle exercises

Pelvic floor muscle exercises are effective in reducing pelvic organ prolapse symptoms.

Lifestyle changes

Being overweight

Being overweight puts extra strain on the pelvic floor muscles. Your symptoms may improve if you lose weight.

Bowel management

It is important to avoid constipation. This puts extra strain on the pelvic floor muscles and can worsen prolapse symptoms. Eating plenty of fruit, vegetables and fibre can help. Make sure you are also drinking enough (1.5 to 2 litres of fluid per day).

Being in a correct position to open your bowels may make going to the toilet easier. Do not strain to empty your bowels. Sit on the toilet with a small footrest. This raises your knees above the hips. Try to rest arms on your knees and breathe out.

Some women who have a back wall prolapse may find it helpful to support the perineum (area between vagina and the back passage) when emptying their bowels. Other women find inserting a finger into the vagina can help splint the back wall and therefore can help empty the bowels more effectively. This can be a useful way to manage a prolapse.

Bladder management

If your feel your bladder does not empty properly, make sure you do not rush when empting your bladder. You may also find it helpful to lean forward a few times to ensure all of the urine in the tube from your bladder has also emptied. Do not push to empty your bladder.

Coughing

Try to manage a chronic cough. Use any prescribed medication for any chest complaint and follow your specific medical advice. If you are a smoker, try to stop.

Lifting

It is not only the weight of the object you lift but the frequency of repeated tasks we do every day. Think about the correct movement pattern when lifting anything no matter how light (e.g. laundry), or heavy and prolonged lifting (e.g. lifting a toddler, shopping). Try to separate weights for carrying, making more frequent trips of lighter loads and lift correctly when picking up from low down. Ideally avoid lifting when possible.

Avoid activities that make the symptoms worse such as standing for long periods. Try to break up your day wherever possible into shorter periods of standing with sitting in between.

Exercise

High impact exercise such as jumping, running or aerobics (e.g. any activity when both feet are off the ground at the same time) may worsen your symptoms, especially if your pelvic floor muscles are not strong. Try low impact exercise instead such as low impact aerobics, cycling, a cross trainer, fast walking, Pilates or swimming.

Vaginal Pessaries

Some women find that after trying lifestyle changes and pelvic floor exercises they wish to try a vaginal pessary. A vaginal pessary is a device that sits inside the vagina to support the pelvic organ prolapse. Many women are unaware of the pessary when it is in place. It is made of plastic or silicone and needs to be removed and inserted a few times each year. You will be advised when this is necessary and where you need to be seen. It may be possible for a woman with a prolapse to use a pessary at any stage of management. Speak to your physiotherapist for more information.

Surgery

A wide variety of operations are available for the treatment of prolapse. The type of surgical repair performed depends on the type of prolapse seen on examination and on the associated symptoms. The main aim of surgery is to correct the vaginal bulge and relieve the symptoms associated with the prolapse.

You will find more detailed information on surgery for pelvic organ prolapse in the Patient Information section on the following websites:

• Click here for The Royal College of Obstetricians and Gynaecologists Website (opens in a new tab)
• Click here for The British Society of Urogynaecology Website (opens in a new tab)

Vaginal oestrogen

A vaginal oestrogen cream or pessary tablet may help with milder symptoms of pelvic organ prolapse particularly dryness and bladder urgency. The vaginal tissues can benefit from an oestrogen supplement. Speak to your GP for more information.

For further physiotherapy advice

For further advice you can leave a message for the Pelvic Health Physiotherapists on 01223 217422