Female Organ Prolapse: Bladder and Uterus Prolapse

Approximately one third of women will suffer from a degree of pelvic organ prolapse in their lifetime.

**Most Common Types of Prolapse:** Uterus,Vagina, Rectum, Urethra, and Small Bowel
**Causes of Pelvic Organ Prolapse:** most commonly occurs due to pregnancy, labour, and childbirth, but other causes include: obesity, respiratory conditions chronic coughing or smoking, constipation, Pelvic Organ Cancer, and Hysterectomy (removal of the uterus.)
**Symptoms of Pelvic Organ Prolapse:**
Pressure or heaviness in the vagina, anus, and/or overall pelvic area (including the feeling that something is falling out), lower back ache, painful intercourse, constipation, vaginal spotting or bleeding, Urinary Incontinence (leakage) and urge to urinate. Not all women experience any symptoms.

How to Measure Prolapse

Pelvic Floor Physiotherapists and OBGYNs use a grading system to measure the degree of prolapse that a patient is experiencing.

Level One Prolapse – the uterus is in the upper half of the vagina.

Level Two Prolapse – the uterus has descended nearly to the opening of the vagina.

Level Three Prolapse – the uterus protrudes out of the vagina.

Level Four Prolapse – the uterus is completely out of the vagina.

Common Questions Answered About Pelvic Organ Prolapse:

Does the level of prolapse determine the amount of symptoms?

No - the degree of prolapse does not indicate the severity of symptoms a patient will feel. Many people experience symptoms with a minor or no prolapse and others with a severe prolapse may feel limited to no discomfort or heaviness.

Will Prolapse Get Better On Its Own?

No. In fact, it can get worse with age or repetitive stressors (e.g. running) or more childbirths. It is instead recommended to make pelvic floor strengthening a daily or weekly part of your exercise routine.

Can You Treat Pelvic Organ Prolapse Naturally?

Yes! According to a randomized controlled trial available in the National Library of Medicine, prolapse and its symptoms are treatable with pelvic floor muscle training.

Working with a Physiotherapist to determine the type and severity of prolapse is helpful in creating a custom treatment plan. Therapists will work with patients to isolate the appropriate muscles of the Pelvic Floor to help lift and strengthen. Kegel exercises are most common, but the method of contraction may vary based on the type of prolapse.

When do I consider Surgery?

If you have tried Pelvic Floor Physiotherapy and are not seeing results or are experiencing pain and discomfort impacting your everyday life then speak to a physician. Surgery is not recommended as the first treatment option as it can sometimes make a prolapse in another part of your pelvic floor worse. You may also have to perform the surgery again later.

What are the risks of Prolapse Surgery?

If you are symptom-free but living with a prolapse, you might want to consider avoiding surgery as the risks associated with surgery include symptoms like the following:

Trouble controlling your bladder (incontinence).
Not being able to empty your bladder.
Pain during sex.
Infection.
Bladder injury.
A hole or opening that forms between two organs in your body, or between your body and your skin. This is called a fistula.

Do the results of Pelvic Organ Prolapse surgery last forever?

No. Pelvic organ prolapse can come back after surgery. About 10 to 20 out of 100 women who have the surgery end up having a second surgery within 10 years. Success is greater when two surgeries are performed together—one to prevent incontinence that can arise after surgery and then the prolapse correction procedure.

Are there any alternatives to Pelvic exercise and physiotherapy outside of surgery?

Yes. There is a device called a pessary that can help you manage your prolapse. It is a device that is inserted into the vagina to hold your pelvic organs in place. It is removable and can be provided at some physiotherapy clinics.

When to see a Pelvic Floor Health Practitioner

If you are experiencing any pelvic or vaginal discomfort or if you (or your partner) has noticed the prolapse, it is likely time to see a Pelvic Floor Physiotherapists for an internal examination. This is to avoid it getting worse especially with age.