Pelvic organ prolapse

Also called Prolapse, Vaginal prolapse

Pelvic organs dropping into the vagina. Around half of women who have given birth have some, and most say nothing for years.

What it is

Pelvic organ prolapse happens when the muscles and tissues supporting the bladder, womb or bowel weaken, and one of them descends into the vagina.

It is very common. Around half of women who have had children have some degree of it on examination, and around 1 in 10 will have surgery for it at some point.

It causes no danger in most cases. What it causes is a substantial and largely silent reduction in quality of life: discomfort, incontinence, difficulty emptying the bladder or bowel, and a significant effect on sex and body image.

Most women wait years before mentioning it, and many assume it is an unavoidable consequence of childbirth and age. It is common, and it is treatable.

The mesh scandal has made some women reluctant to consider surgery at all, and that history deserves honest acknowledgement rather than dismissal.

Signs you might notice

A dragging or heavy feeling in the vagina, worse at the end of the day or after standing.

A visible or palpable bulge.

Difficulty emptying the bladder or bowel, sometimes needing to push the bulge back to do so.

Urinary leakage, urgency, or recurrent urinary tract infections.

Discomfort during sex.

Symptoms better when lying down.

How it can affect day-to-day life

Silence is the main obstacle. Women do not raise it with GPs, and GPs do not ask.

It affects exercise, work involving standing or lifting, and intimacy, and each of those losses is attributed to age instead.

Constipation and straining make it worse, and treating constipation is genuinely part of managing prolapse.

Pelvic floor muscle training with a specialist physiotherapist is first-line treatment and works well for mild to moderate prolapse. Access varies, and many women are offered a leaflet instead.

Supporting someone well

Raise it. It is common, it is treatable, and nobody has to live with it.

Ask for referral to a pelvic health physiotherapist. Supervised training over several months is what works; a leaflet is not equivalent.

Treat constipation and avoid straining.

Ask about a pessary, a device that supports the prolapse. They are effective, reversible, and often not offered.

Vaginal oestrogen helps tissue quality after the menopause and is separate from systemic HRT.

Consider surgery with full information, including an honest discussion of mesh history and of non-mesh options.

Where to get help

A GP can examine, treat and refer. Many areas allow self-referral to pelvic health physiotherapy.

The Pelvic Obstetric and Gynaecological Physiotherapy group and the POGP website list services.

Sudden inability to pass urine needs urgent assessment. See urinary retention.