Advice on prolapse
It isn’t often spoken about, but pelvic organ prolapse is very common. We’ve posed the questions you might be too embarrassed to ask your GP
What is prolapse?
Your uterus, bladder and rectum are usually held in place by ligaments known as your pelvic floor. But if your pelvic floor stretches and weakens, these organs can bulge into your vagina. Experts don’t know for certain how many women are affected because many don’t see their doctor, but it’s estimated at least half of those over 50 have some symptoms – by 80, one in ten women will have had surgery to treat prolapse.
What causes prolapse?
The most common cause is pregnancy and giving birth, because this stretches your pelvic floor. You can still have prolapse even if you haven’t had children, though. Being overweight can put strain on your pelvic floor muscles, as can chronic constipation or coughing (which is why smoking is a risk factor). “Prolapse is more common after the menopause because the tissue support becomes weaker due to a drop in hormones,” says consultant gynaecologist Pandelis Athanasius.
How would I know I had it?
“You might feel something is ‘coming down’ or even see something bulging out through the opening,” says Pandelis. Symptoms include recurrent water infections, finding it hard to empty your bladder, discomfort during sex, back pain and leaking urine when exercising, laughing or coughing.
What can my doctor do?
If you have symptoms, see your GP. In milder cases, you will just be given lifestyle advice – for example, losing weight and managing a chronic cough or constipation. You can have a pessary inserted to hold the organs in place if you have a uterine or anterior wall prolapse (see below, left), and sometimes vaginal oestrogen can help. Your doctor may also refer you for training in pelvic floor exercises. In more severe cases, you might need surgery to repair your pelvic floor.
How can I prevent prolapse?
Keeping to a healthy weight, quitting if you smoke, having a healthy, high-fibre diet and avoiding too much high-impact exercise could help lower your risk. Pelvic floor exercises may also help. Just pull in your pelvic floor muscles (as though you’re stopping your urine flowing mid-stream) and hold for three seconds, then release for three seconds, before tensing them again. Start with ten and work up to 20, repeating three times a day.