It’s estimated that 50% of childbearing women develop prolapse. Pelvic organ prolapse (POP) occurs when normal vaginal supports are damaged (childbirth, surgery, falls, pelvic fractures, heavy lifting). As a result the pelvic organs sag down into the vaginal walls. If prolapse progresses bulging tissue can be felt or seen at the vaginal entrance.

What causes prolapse?

• Our race and genes - Caucasian women are more likely to develop prolapse than African American women. If your mother had a prolapse then you have a higher risk of developing a prolapse (inherited connective tissue).
• Injury during pregnancy, childbirth, surgery (hysterectomy) and accidents, weaken supporting structures.
• Lifestyle habits – chronic bowel straining, heavy lifting, poor posture, chronic coughing and smoking.
• Obesity – too much weight significantly adds to the risk of developing prolapse.
• Menopause (declining oestrogen levels) and aging.  
• Loss of PFM strength contributes to prolapse.

Types of prolapse

Anterior vaginal or front wall prolapse occurs when the bladder or urethra descend into the front vaginal wall.
 
Posterior vaginal or back wall prolapse occurs when the rectum or small intestine descends into the back vaginal wall.
 
Utero-vaginal descent occurs when the cervix descends vaginally.

Vaginal vault prolapse occurs when the upper part of the vaginal sags down into the lower vagina. This affects women who have  previously had a hysterectomy.

Rectal prolapse occurs when the rectum descends down through the anus or the upper rectum can slide down inside the  rectum like a tube within a tube.

Not all women with prolapse have bothersome symptoms while others describe pelvic heaviness, cannot retain a tampon, notice changes in their urine stream or discomfort during intercourse. As a prolapse worsens a vaginal bulge is noticed and some women feel as though they are ‘sitting on a ball’. Urinary frequency or incomplete bladder emptying may be noticed and the bulging vagina or uterus may need to be pushed up to start urinating. Prolapse of the rectum into the back vaginal wall may need finger vaginal pressure to help the bowel empty.

Many women manage prolapse without surgery by using a pessary support (ring shaped support inserted high vaginally) and avoiding bowel straining, heavy lifting and over challenging exercise. Not all repair surgeries are successful as 1/3 of women undergo repeat corrective surgery. Be sure to learn and discuss possible complications associated with different prolapse surgical approaches with the surgeon if you are considering prolapse repair. Building PFM strength, maintaining tall posture, losing weight, modifying life style and lifting the PFMs with activity are recommended prolapse control measures.

Gynaecologists, urogynaecologists and women’s health physiotherapists will identify different types of prolapse. Read the practical section in Hold It Mama to identify your own vaginal prolapse along with treatment and prevention.