Vaginal Prolapse

A vaginal prolapse happens when the muscles and support structures inside the pelvis weaken, causing the pelvic organs (womb, bladder, urethra or rectum) to drop down into the vagina. This causes a sensation of vaginal heaviness, bulging or dragging or feeling of ‘something coming down.’

Prolapse can also lead to bladder, bowel or sexual issues.

Vaginal prolapse can affect 1 in 3 women who have had children.

There are different types of prolapse and sometimes more than one type can occur at the same time.

Front Wall Prolapse / Cystocoele

The wall giving support to the bladder is weak, causing the bladder to prolapse downwards. This may lead to problems emptying your bladder fully as well as feelings of bladder urgency and / or leakage.

Back Wall Prolapse / Rectocoele

The wall giving support to the rectum is weak, causing it to bulge downwards. This may lead to difficulty fully emptying your bowels, or having to strain to empty fully. You may feel some bowel urgency and sometimes leakage.

Uterine Prolapse

This is when the womb prolapses downwards into the vagina, causing your cervix to descend into the vagina.

Other prolapse symptoms might include:

• A feeling of vaginal laxity or looseness
• Difficulty keeping a tampon in place
• Discomfort with sex
• Low Back ache

Your prolapse symptoms may increase with:

• Lots of heavy lifting
• Ongoing constipation
• Being overweight
• Hormonal changes
• If you have a family history of prolapse

Physiotherapy will help you manage your symptoms of prolapse. Treatments include:

• Advice on lifestyle adjustments aimed at reducing downward pressure into your pelvis eg weight loss, reduction of lifting and constipation management
• Adopting good habits for bladder and bowel emptying
• Pelvic floor muscle (PFM) rehabilitation
• Advice on appropriate exercise

Other treatments that help include:

• Pessaries – a vaginal pessary is a device made of silicone or plastic that can be inserted inside your vagina to give support to the walls. Once inserted it should feel comfortable, but will need to be regularly checked. There are several different types and it can be ‘trial and error’ to get the right one for you. You can still have sex with a pessary inside.
• Vaginal oestrogen – A course of vaginal oestrogen may help some women when the vaginal tissues are very dry. This needs to be prescribed by your doctor or hospital team.
• Surgery – This may be appropriate for some women, but only if all other options are exhausted first.