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Conditions

Gynecology · Pelvic floor

Pelvic organ prolapse

Understand pelvic organ prolapse, its assessment and the options that may ease symptoms according to your priorities.

Editorial publication · Medical review pending.

Understand

Pelvic organ prolapse is the descent of one or more pelvic organs towards the vagina. It may involve the bladder, uterus, rectum or the top of the vagina after hysterectomy. More than one compartment may be involved.

Possible symptoms

It may cause no symptoms. Otherwise, pelvic heaviness, a vaginal bulge, discomfort during sex, or bladder or bowel difficulties may occur. Symptoms can be more noticeable when standing, straining or later in the day.

Causes and associated factors

The pelvic floor and supporting tissues may weaken over time. Pregnancy and childbirth, menopause, pelvic surgery, repeated straining from constipation, chronic cough, excess weight or heavy lifting may contribute; no single factor explains every case.

Diagnosis

The clinician asks about bladder, bowel and sexual symptoms and their effect on daily life. With your agreement, a pelvic examination identifies the organs involved and the degree of prolapse; it may be repeated while standing if a lying examination does not explain the symptoms.

Tests

Imaging is usually unnecessary when prolapse is seen on examination. A urine test, measurement of urine left after voiding or other investigations may be offered when bladder or bowel symptoms, pain or planned surgery make them relevant.

Course of the condition

The course is often slow and varies. A prolapse that causes little bother can be monitored without treatment. Care aims to improve symptoms and quality of life; recurrence remains possible, including after surgery.

Care options

Options include addressing constipation or cough, supervised pelvic floor muscle training and a properly fitted and reviewed vaginal pessary. Vaginal oestrogen for symptoms associated with menopause or surgery may be discussed according to the situation. The choice considers symptom burden, the organs involved, general health, sexual activity and possible pregnancy plans. Each operation has its own benefits, risks and uncertainties.

When to consult

Seek advice if you feel or see a vaginal bulge, heaviness limits your activities, or you have bladder, bowel, sexual symptoms or bleeding. You may ask for a companion or chaperone and can ask for the examination to stop at any time.

Urgent help

If you cannot pass urine, especially with lower abdominal pain or swelling, seek immediate medical help. Severe pain, heavy bleeding, fever or feeling faint also need prompt assessment and should not automatically be attributed to prolapse.

Questions for your doctor

  • Which organs and symptoms are involved?
  • Would monitoring or pelvic floor therapy be enough?
  • How can I try and care for a pessary safely?
  • What benefits, risks and recurrence risks come with each option?
  • How do pregnancy plans and sexual activity affect the choice?

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A procedure linked to a condition does not establish an indication for your individual situation.

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