Cystocele

Pelvic organ prolapse is bulging of one or more of the pelvic organs into the vagina.

These organs are the uterus, vagina, bowel and bladder.

Symptoms may include:

• a sensation of a bulge or something coming down or out of the vagina, which sometimes needs to be pushed back
• discomfort during sex
• problems passing urine, such as slow stream, a feeling of not emptying the bladder fully, needing to urinate more often and leaking a small amount of urine when you cough, sneeze or exercise (stress incontinence)

Some women do not have any symptoms.

Read more about the symptoms of pelvic organ prolapse.

When to see your GP

Pelvic organ prolapse is not life threatening, but it can affect your quality of life.

See your GP if you have any of the symptoms of a prolapse, or if you notice a lump in or around your vagina that you have not felt before.

Your GP will often need to carry out an internal examination of your pelvis to diagnose a prolapse.

Read more about diagnosing pelvic organ prolapse.

Types of prolapse

Pelvic organ prolapse can affect the front, top or back of the vagina. The main types of prolapse are:

• anterior prolapse (cystocoele), where the bladder bulges into the front wall of the vagina
• prolapse of the cervix or top of the vagina, where the cervix or uterus drops, and can be the result of previous treatment to remove the womb (hysterectomy)
• posterior wall prolapse (rectocoele or enterocoele), when the bowel bulges forward into the back wall of the vagina

It is possible to have more than one of these types of prolapse at the same time.

Why does prolapse happen?

Prolapse is caused by weakening of tissues that support the pelvic organs. This happens for a number of reasons.

In many women, the strain of childbirth weakens these tissues. Up to half of all women who have had children are affected by some degree of prolapse.

It is also more common as women get older, particularly in those who have gone through the menopause.

Things like being overweight, having a persistent cough and having long-term constipation can increase your risk of developing a prolapse.

Prolapse can also be caused by rare genetic conditions that affect your body tissues, such as Marfan syndrome.

Read more about the causes of pelvic organ prolapse.

Can a prolapse be prevented?

There are several things you can do to reduce your risk of prolapse, including:

• doing regular pelvic floor exercises
• maintaining a healthy weight or losing weight if you are overweight
• eating a high-fibre diet with plenty of fresh fruit, vegetables and wholegrain bread and cereal to avoid constipation and straining when going to the toilet
• avoiding heavy lifting

If you smoke, stopping smoking may also help reduce your risk of a prolapse.

How is prolapse treated?

Many women with prolapse do not need treatment as the problem does not seriously interfere with their normal activities.

Lifestyle changes such as weight loss and pelvic floor exercises are usually recommended in mild cases.

If the symptoms require treatment, a prolapse may be treated effectively using a device that is inserted into the vagina called a vaginal pessary. This helps to hold the prolapsed organ in place.

Surgery may also be an option for some women. This usually involves giving support to the prolapsed organ, but in some cases complete removal of the womb (hysterectomy) is required.

Most women experience a better quality of life after surgery, but there is a risk of problems remaining or even getting worse.

Read more about treating pelvic organ prolapse.