What is pelvic organ prolapse?
Pelvic Organ Prolapse (POP) is a condition in which the pelvic organs, the bladder, uterus,
vagina itself and/or rectum, have moved downward and sit in a lower position creating a
bulge into the vaginal walls. It affects up to half of all cisgender women. Around 20-40% of
all cisgender women experience prolapse symptoms at some point which bother them or
have an impact on their quality of life.
It is estimated that around 1 in every 9 cis women will
eventually require surgery for prolapse. And that 1⁄3 of those who have had surgery for POP
will need a second surgery for it.
What are the symptoms of prolapse?
● a sensation of heaviness, pressure, dragging, a lump or bulge in the area of the
vagina
● leakage of urine, difficulty fully emptying the bladder, recurrent urinary tract and/or
kidney infections
● deep pain, discomfort or reduced sensation with intercourse
● difficulty emptying the bowel and sometimes needing to assist, or incontinence of
wind or faeces
6
● Discomfort, pulling, dragging or ache in the lower abdomen and/or lower back
● Bleeding, discharge or infection in the genital region.
Prolapse symptoms tend to feel worse when we have been on our feet for longer periods,
have been more physically active, towards the end of the day, we need to open our bowel.
They tend to be eased after rest, especially first thing in the morning or after a period of lying
down. Symptoms of prolapse can vary from none at all, mild, moderate to having a severe
impact on our ability to perform usual activities and reducing our quality of life. Many of the
1 PDF: UK Clinical Guideline for Best Practice in the Use of Vaginal Pessaries for Pelvic Organ
Prolapse. International Urogynaecological Association (IUGA) website.
https://www.iuga.org/whats-new/guideline-on-best-practice-in-the-use-of-vaginal-pessaries Published
March 2021. Accessed August 2022.
2 Brown et al 2002, Pelvic organ prolapse surgery in the United States, Am J Obstetr Gynecol, (186)
pp712-716
3 Wilcox et al 1994, Hysterectomy in the United States, 1988-1990, Obstet Gynecol, (83), 549-555
4 Olsen et al 1997, Epidemiology of surgically managed pelvic organ prolapse and urinary
incontinence, Obstet Gynec (89), 501-506
5 Wu et al 2013, American Urogynecologic Society (AUGS) 34th Annual Scientific Meeting: Paper 32,
presented Oct 18 2013
6 PDF Guide: Treatment Options for Pelvic Organ Prolapse. Australian Commission on Safety and
Quality in Health Care website.
https://www.safetyandquality.gov.au/sites/default/files/2020-01/treatment_options_for_pelvic_organ_pr
olapse_pop_-transvaginal_tv_mesh-_information_for_consumers_patient_resource.pdf Published
May 2018. Accessed August 2022.
7 PDF: UK Clinical Guideline for Best Practice in the Use of Vaginal Pessaries for Pelvic Organ
Prolapse. International Urogynaecological Association (IUGA) website.
https://www.iuga.org/whats-new/guideline-on-best-practice-in-the-use-of-vaginal-pessaries Published
March 2021. Accessed August 2022.
8 Hayden et al 2010, An International Urgogynaecological Association (IUGA)/International
Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction, vol 21,
pp5-26
symptoms can have possible other causes, so it is important to be assessed by a health
care worker who is trained and experienced in pelvic floor function and dysfunction to ensure
that the correct diagnosis and management options are given.
Why does prolapse happen?
There are many factors which may influence the likelihood of developing or worsening POP.
Some examples include:
● pregnancies/births
● long term/recurrent/severe constipation
● heavy lifting
● high impact exercise
● poor pelvic floor muscle function
● heavy abdominal exercises
● long term/recurrent respiratory problems involving repeated coughing and sneezing
● increased body weight
● hormonal and pelvic tissue changes around menopause
● collagen-associated connective tissue disorders eg – hypermobile Ehlers Danlos
Syndrome
10
● after hysterectomy or other types of surgeries in the pelvis
● family history of POP
What are the Management Options for Prolapse?
Prolapse may have an impact on our function, participation in activities and quality of life. It
is up to the person with prolapse how they would like to respond to it. So it can be useful to
be aware of and explore the possible management options with your health care team.
Some of these options include:
● Leaving it alone, not taking action or seeking treatment
● Pelvic floor muscle retraining exercises
● Modifying lifestyle/activities
● Vaginal Support Pessaries
● Vaginal oestrogen creams or pessaries
9 PDF Guide: Treatment Options for Pelvic Organ Prolapse. Australian Commission on Safety and
Quality in Health Care website.
https://www.safetyandquality.gov.au/sites/default/files/2020-01/treatment_options_for_pelvic_organ_pr
olapse_pop_-transvaginal_tv_mesh-_information_for_consumers_patient_resource.pdf Published
May 2018. Accessed August 2022.
10 Pelvic Organ Prolapse and Collagen-Associated Disorders. Int Urogynecol J. 2012; 23(3): 313–319.
Published online 2011 Aug 3. Accessed August 2022 online:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282004/
11 PDF Guide: Treatment Options for Pelvic Organ Prolapse. Australian Commission on Safety and
Quality in Health Care website.
https://www.safetyandquality.gov.au/sites/default/files/2020-01/treatment_options_for_pelvic_organ_pr
olapse_pop_-transvaginal_tv_mesh-_information_for_consumers_patient_resource.pdf Published
May 2018. Accessed August 2022.
12 Awwad, Sayegh, Yeretzian and Deeb 2012, Prevalence, risk factors and predictors of pelvic organ
prolapse: a community-based study. Menopause 2012, Nov vol 19 (11), 1235-41
● Surgerie
● Support garments (eg – https://srchealth.com/products/restore)
Your GP, Pelvic Health Physiotherapist and Gynaecologist can assist you with discussing
and navigating these management options in your individual situation.
Some Physiotherapists have specific additional training in the assessment and management
of pelvic floor dysfunction including prolapse. They can assist with diagnosis, prescribe
specific pelvic floor muscle retraining exercises, and provide education and advice about
lifestyle and activity modifications, bladder, bowel and sexual function, and support garments
to assist with prolapse. Some of these physiotherapists, including Tabitha at our clinic, have
additional training and experience in the fitting and management of support pessaries.
For more information about the use of vaginal support pessaries and the role of
physiotherapy in the management of POP, please watch this space for an upcoming post all
about them.
If you are interested in seeing Tabitha for an Initial Pelvic Floor Physiotherapy Assessment
or for a Pessary Fitting, please contact Hawker Place Physiotherapy and Pilates:
Ph: (02) 6255 2033
Book online: https://hawkerplacephysio.com.au/online-booking
References
PDF Guide: Treatment Options for Pelvic Organ Prolapse. Australian Commission on Safety and
Quality in Health Care website.
https://www.safetyandquality.gov.au/sites/default/files/2020-01/treatment_options_for_pelvic_organ_pr
olapse_pop_-transvaginal_tv_mesh-_information_for_consumers_patient_resource.pdf Published
May 2018. Accessed August 2022.
PDF: UK Clinical Guideline for Best Practice in the Use of Vaginal Pessaries for Pelvic Organ
Prolapse. International Urogynaecological Association (IUGA) website.
https://www.iuga.org/whats-new/guideline-on-best-practice-in-the-use-of-vaginal-pessaries Published
March 2021. Accessed August 2022.
13PDF Guide: Treatment Options for Pelvic Organ Prolapse. Australian Commission on Safety and
Quality in Health Care website.
https://www.safetyandquality.gov.au/sites/default/files/2020-01/treatment_options_for_pelvic_organ_pr
olapse_pop_-transvaginal_tv_mesh-_information_for_consumers_patient_resource.pdf Published
May 2018. Accessed August 2022.
PDF: UK Clinical Guideline for Best Practice in the Use of Vaginal Pessaries for Pelvic Organ
Prolapse. International Urogynaecological Association (IUGA) website.
https://www.iuga.org/whats-new/guideline-on-best-practice-in-the-use-of-vaginal-pessaries Published
March 2021. Accessed August 2022.
14Restore Support Garments section, SRC Health Website. https://srchealth.com/products/restore
Accessed August 2022.
Brown et al 2002, Pelvic organ prolapse surgery in the United States, Am J Obstetr Gynecol, (186)
pp712-716
Wilcox et al 1994, Hysterectomy in the United States, 1988-1990, Obstet Gynecol, (83), 549-555
Olsen et al 1997, Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence,
Obstet Gynec (89), 501-506
Wu et al 2013, American Urogynecologic Society (AUGS) 34th Annual Scientific Meeting: Paper 32,
presented Oct 18 2013
Hayden et al 2010, An International Urgogynaecological Association (IUGA)/International Continence
Society (ICS) joint report on the terminology for female pelvic floor dysfunction, vol 21, pp5-26
Pelvic Organ Prolapse and Collagen-Associated Disorders. Int Urogynecol J. 2012; 23(3): 313–319.
Published online 2011 Aug 3. Accessed August 2022 online:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282004/
Awwad, Sayegh, Yeretzian and Deeb 2012, Prevalence, risk factors and predictors of pelvic organ
prolapse: a community-based study. Menopause 2012, Nov vol 19 (11), 1235-41
Restore Support Garments section, SRC Health Website. https://srchealth.com/products/restore
Accessed August 2022.
