• Seeing or feeling a lump in the vagina
  • A sense of ‘something coming down’
  • A ‘dragging feeling’
  • Bladder problems – stress, urge or overflow urinary incontinence (see bladder problems)
  • Difficulty emptying the bowels
  • Lower back or pelvic pain
  • Pain or discomfort during sexual intercourse

What is Pelvic Organ Prolapse?

The vagina and its surrounding structures (bladder, rectum, etc.) are attached to the pelvis by connective tissues. These tissues help form walls around the vagina, and ensure that normal urinary voiding and bowel movements can occur As the pelvic muscles become weak the connective tissues can fail, allowing pelvic structures like the bladder or rectum to bulge into the vaginal wall.

This can cause the following symptoms:

A feeling of vaginal fullness, heaviness, or even pain
Pain or discomfort during intercourse
Loss of bladder and/or bowel control
Involuntary urination or inconsistent urinary stream
Difficulty with bowel movements
Recurrent urinary or bladder infections

What causes pelvic organ prolapse?

Pelvic muscles and connective tissues which have been weakened with age are the primary cause, but many other factors may play a role. These may include vaginal childbirth, previous vaginal surgeries, menopause, smoking, diabetes, obesity, repeated heavy lifting, chronic coughing and chronic constipation. Sometimes pelvic organ prolapse can be caused simply by aging or genetic factors.

The type of prolapse you have is named according to which structure has slipped:

Cystocoele (bladder prolapse): the bladder drops down and bulges into the front wall of the vagina.
Rectocoele (prolapse of the rectum): the rectum bulges into the back wall of the vagina.
Uterine Prolapse (prolapse of the uterus): the uterus (womb) drops down into the vagina. In severe cases it can drop below the vaginal entrance, to sit outside the body.

Physiotherapy for Prolapse

The goals of Physiotherapy are to reduce the symptoms caused by the prolapse and to improve your pelvic floor support. Treatment will always involve a lot of education, to teach you simple measures which can make a big impact on your comfort and control, for instance instructions on how to pass bowel movements without straining.

Treatment is often focused around the pelvic floor muscles – the sling of muscles which help to support and control the bladder. You will be taught how to identify them, how to tighten them (Kegel exercises) and how to use them functionally to help support your pelvic organs during daily activities.

Treatment techniques may include computerized biofeedback, to teach pelvic floor muscle awareness, bladder retraining, posture re-education, exercises for the abdominals and other ‘core’ muscles. A home exercise program will always be an important part of your treatment.