Prolapse

What is Prolapse?

Women generally have three organs in the pelvic cavity (the space inside the hip bones and the tailbone), including the bladder, uterus, and rectum. A prolapse is where one or more of these organs slip downwards away from their usual position.

What are the Different Types of Prolapse?

There are many different types of prolapse, which include:

• Apical / Uterine Prolapse – A prolapse where the uterus falls downwards, collapsing into the vaginal canal.
• Cystocele / Cystourethrocele – A form of prolapse where the bladder and/or urethra falls down and backwards into the anterior wall of the vagina.
• Rectocele – A form of prolapse where the rectum falls down and forwards into the posterior wall of the vagina.

The degree to which one or more of these organs slip downwards determines the severity of the prolapse.

What Causes a Prolapse to Occur?

Several factors can lead to prolapse, including:

• A weakness of the pelvic floor muscles
• Damage to connective tissue in the pelvis
• Pregnancy
• Childbirth esp. involving prolonged labour or use of forceps
• History of chronic respiratory conditions
• History of chronic constipation or straining when making a bowel movement
• Regular heavy lifting
• Elite / high-level athletes involving high impact and high load sports. E.g. running, gymnastics and weight lifting.
• Obesity
• Age
• Hormonal changes. E.g. menopause

What are the Symptoms of Prolapse?

The symptoms present for each type of prolapse vary slightly, but generally, prolapse symptoms include:

• A feeling of fullness in and around the vagina, or in some cases an observable bulge extending from the vagina
• A feeling of pressure in the lower abdomen
• Low back pain
• A feeling of being unable to empty the bowel or bladder, potentially leading to assisted digital emptying.
• Bleeding, discharge or infection

How is Prolapse Diagnosed?

Usually, a clinical diagnosis can be made using the information you have given and a physical examination. During this examination, your physiotherapist may need to perform an internal exam to assess the potential weakness of the pelvic floor or damage to connective pelvic tissue and gain an idea of the position of the pelvic organs.

What Treatments are available for Prolapse?

Often, physiotherapy is considered the first line of treatment for prolapse and can include:

• Education
• Lifestyle Recommendations
• A pelvic floor exercise program
• Ultrasound to assist with pelvic floor activation
• Electrical stimulation to assist with pelvic floor activation
• Internal support devices, e.g. pessary
• Adjustment of usual toileting habits
• Advice to modify or manage lifting and exercise habits
• Controlled coughing

What Results Can You Expect?

A large proportion of people with prolapse will have their symptoms improved or resolved with physiotherapy treatment. However, if left untreated, often the problem continues to worsen gradually.

Will You Need Surgery?

A percentage of people who may not experience enough improvement with physiotherapy alone, or depending on the severity of their prolapse, may need to have surgery to resolve their symptoms.

For more information please consult your physiotherapist with a special interest in pelvic floor conditions.