Causes and treatment

The biggest cause of prolapse is pregnancy and birth, though a number of other factors such as family history, lifestyle and certain medical conditions can also cause prolapse. Treatment can vary from simple lifestyle changes to surgery.

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What causes vaginal prolapse?

The biggest cause of prolapse is pregnancy and birth – almost one in two (or 50 per cent of) women who have been pregnant will have some kind of prolapse. Your pelvic floor is weakened during pregnancy (by extra weight and hormone changes) and then again when you give birth – particularly if you had more than one baby, your baby was big or you had to push for a longer time than usual. 

You are also more likely to have a vaginal prolapse if:

• someone in your family has also had a prolapse
• you have been through menopause and you have low levels of the hormone oestrogen 
• you are over overweight
• you cough a lot or strongly (because you smoke, have bad bronchitis or asthma)
• you often have constipation and need to push hard or strain to go to the toilet
• you regularly lift heavy things (like furniture, older children etc.)
• you have fibroids or a pelvic tumour
• you have had surgery in the past to treat a vaginal prolapse.

What are the signs of prolapse?

Many women don’t notice a prolapse when it first happens or if the organ has not moved far. If your prolapse has moved further down (and is a higher stage) you may:

• sense that your vagina is different. It may feel heavy or like it is dragging. This may be more noticeable when you sneeze or cough, have been standing for a long time, have done something very physical such as running or at the end of the day. 
• see or feel a lump. This can be inside your vagina or poking out of it. 
• have achy pain in your pelvic region or back.
• have difficulty going to the toilet. You may need to urinate a lot, have trouble emptying your bladder or bowel, or urinate accidentally. 
• have a urinary tract infection (UTI) that often comes back again.

Some women also say they have discomfort, pain or less sensation during sex. 

How is prolapse diagnosed?

Your local doctor or GP can diagnose a prolapse. They will most likely: 

• ask you questions about the history of your health
• examine your body
• look into your vagina or inside your bottom (rectum)
• ask you to cough, push down or tighten with your pelvic muscles. 

Many prolapses are discovered during regular cervical screening tests. 

How is prolapse treated?

The kind of treatment you have will depend on:

• which organ has moved (prolapse type) and how far (prolapse stage)
• your age, health and medical history
• whether you want to have (more) children.

Your doctor may refer you to a women’s physiotherapist or a doctor who specialises in women’s pelvic floor problems (called a urogynaecologist). They may recommend one or more of these treatment options: 

Lifestyle changes to stop doing the things that may cause the prolapse or make it worse. This can include losing weight, quitting smoking, eating and drinking differently, and lifting less. These changes aim to fix prolapses.

Physiotherapy to strengthen the pelvic floor that supports your organs. A physiotherapist can design a special pelvic exercise program for you. Physiotherapy aims to fix prolapses.

A pessary (a small plastic or silicon support) that is placed inside your vagina to hold up the prolapsed organ. Pessaries don’t fix prolapses but they can reduce or lessen the symptoms of prolapse and help you live more comfortably. 

Surgery to repair the torn or stretched pelvic floor. There are several types of prolapse surgery but all of them try to fix the prolapse and prevent it from happening again. Some surgeries will mean you can no longer have children. 

Treatment is not always successful and sometimes a prolapse will come back. 

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