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The pelvic organs, such as the womb, rectum and bladder, are held in place by muscles, tissue and ligaments. Prolapse happens when one or more of these organs slips down from its normal position and into the vagina, because the supportive tissues have become weak.
Symptoms depend on the organ that has been affected, but prolapse commonly causes:
• a sensation of something coming down or out of the vagina
• an uncomfortable feeling of fullness
• difficulty having sex
• leaking a small amount of urine when you cough, sneeze or exercise (stress incontinence)
These are several types of pelvic organ prolapse:
• uterine prolapse - the womb pushing through into the vagina
• enterocele - part of the small bowel pushing through into the vagina
• rectocele - part of the rectum pushing through into the vagina
• cystocele - part of the bladder pushing through into the vagina
• vaginal vault prolapse - the top of the vagina sagging (often associated with a cystocele, rectocele or enterocele)
Who is affected?
Up to half of all women who have had children are affected by some degree of prolapse.
It is more common as women get older, particularly in those who have gone through the menopause. It is rare in women who have not had children.
Prolapse is also associated with being overweight and with having a persistent cough.
It is the most common reason for hysterectomy in women aged over 50.
Stages of prolapse
The severity of the prolapse can be determined using the following grading system.
• stage 1: the prolapse is more than 1cm above the opening of the vagina
• stage 2: the prolapse is 1cm or less from the opening of the vagina
• stage 3: the prolapse sticks out of the vagina opening more than 1cm, but not fully
• stage 4:Â the full length of theÂ prolapseÂ bulges out of the vaginaÂ
How is prolapse treated?
Mild cases of prolapse may not need treatment. Lifestyle changes such as weight loss and pelvic floor exercises may be recommended instead.
More severe cases of prolapse may be treated effectively using a device that is inserted into the vagina called a vaginal pessary. This helps to hold the prolapsed organ in place.
Surgery can also be tried. For example, a mesh can be inserted to support the womb, in the case of a uterine prolapse.
The impact of surgery on bowel, bladder and sexual function can be unpredictable and may make symptoms worse or result in new symptoms, such as leakage of urine or problems with intercourse.
Some women who have had surgery may need further surgery for prolapse of the vaginal walls.