What you need to know about prolapse
Prolapse is a condition that is relatively common in women who have had babies, but you may never have heard of it. Research estimates that it may affect around 30-40% of all women who have given birth, but in reality, that figure may be much higher because many women with prolapse symptoms don’t seek medical attention or advice.
First, some love
I want you to know that if you do have a prolapse, that does not in any way diminish your worth as a human, as a woman, or as a mum. Prolapse is very common, and many people feel ashamed and embarrassed that this has happened to their body. You did not do anything to cause your prolapse, and you deserve care, compassion, medical treatment, and to feel dignity and pride in your body.
What is prolapse?
Prolapse refers to a condition where the pelvic organs (such as the uterus, bladder, or rectum) may bulge or “prolapse” into the vaginal canal. This can occur as a result of damage or weakening of the muscles and tissues that support the pelvic organs during childbirth.
There are different types of prolapse, including:
- Cystocele: When the bladder bulges into the vaginal wall. This is the most common type of prolapse.
- Uterine prolapse: When the uterus descends into the vaginal canal. This is the second-most common type of prolapse.
- Rectocele: When the rectum bulges into the vaginal wall.
- Enterocele: When the small bowel presses against and moves the upper vaginal wall.
- Vault prolapse: When the top of the vagina comes down after the uterus has been removed via hysterectomy.
How do I know if I have a prolapse?
Symptoms of prolapse may include a feeling of heaviness or pressure in the pelvic area, difficulty with bowel movements or urination, or a visible bulge in the vaginal area. In some cases, there may be no symptoms at all. There are a variety of treatment options for prolapse, depending on the severity of the condition and the patient’s symptoms. These may include pelvic floor exercises, vaginal pessaries, or surgery.
How is prolapse diagnosed?
Prolapse is usually diagnosed through a physical examination. During the examination, your GP will typically perform a pelvic exam to assess the position and descent of the pelvic organs. They may also perform a rectal exam to evaluate your rectum and anus. In addition to the physical examination, a healthcare provider may also use other diagnostic tools such as:
- Pelvic imaging: An ultrasound or MRI can provide detailed images of the pelvic organs and help determine the extent of the prolapse.
- Urodynamic testing: This test measures the pressure and flow of urine to evaluate the function of the bladder and urethra.
- Cystometry: This test measures the pressure and volume of the bladder to evaluate the function of the bladder and urethra.
- Anorectal manometry: This test evaluates the function of the rectum and anus.
Unfortunately, some of these tests can be uncomfortable and may require some preparation, such as avoiding food and drink before the test. Your GP will provide instructions on how to prepare for any tests they recommend. It is also important to let your GP know if you experience any symptoms of prolapse, such as pelvic pressure or discomfort, difficulty urinating or bowel movements, or any visible bulging in your vaginal area.
What can I do about my prolapse?
Not everyone needs surgery to treat their prolapse. Here are some options you can try, with your GP or health professional’s agreement, before seeking surgical options.
- Pelvic floor exercises (also known as Kegel exercises): These exercises strengthen the muscles that support the pelvic organs, which can help alleviate symptoms of prolapse.
- Pessary: A pessary is a device that is inserted into the vagina to support the pelvic organs.
- Hormone therapy: Hormone therapy can help alleviate symptoms of prolapse by improving the tone and elasticity of the vaginal tissues.
- Lifestyle changes: Maintaining a healthy weight, avoiding constipation, and avoiding heavy lifting can help reduce the symptoms of prolapse.
- Physiotherapy: A physiotherapist can teach you exercises and positions to help reduce your symptoms and improve your quality of life. There are specialist pelvic floor physiotherapists and women’s health physiotherapists who may be able to offer expert advice; ask your GP to refer you to someone with this area of expertise.
It is important to note that these options may not always be successful in treating prolapse and may not be suitable for everyone. Talk to your GP, specialist, or physio to work out the best treatment plan for your circumstances and condition.
What if I do need surgery?
If you have tried the above treatment methods and they haven’t worked, or if your GP or physio thinks you would benefit from knowing your surgical options, they will refer you to a specialist gynaecologist. They will give you some ideas of what surgery they might recommend that they think will help your prolapse. Sometimes these surgeries involve repairing tissue, shifting or removing the uterus or other reproductive organs, or using mesh or other methods of support.
You have the right to ask questions about the surgery, to have multiple appointments to find out everything you need to know, to take a support person with you to help you get information, and to refuse treatment. Many people feel nervous about surgical options, and it’s important to remember that it is up to you and your body.
Please remember that prolapse is unfortunate, but it doesn’t need to mean the end of your physical, active life. You should not have to suffer in silence! Please seek advice and help from healthcare professionals and do what is right for your body.
For more information
- Continence NZ
- Active and POP
- Physiotherapy New Zealand
- Pelvic Floor Dysfunction Support NZ
- Database of Pelvic Floor Safe Fitness Instructors
- Health Navigator