Pelvic Organ Prolapse (SPARC)

This page provides information about pelvic organ prolapse. If you have any further questions or concerns, please speak to the staff member in charge of your care.

What is Pelvic Organ Prolapse?

A pelvic organ prolapse is a common condition that can affect women of all ages. It occurs when one or more of your pelvic organs loses some of their normal support and pushes down into your vagina. This could either be your bladder (anterior wall), uterus (uterine), rectum (posterior wall) or a combination of all three.

Prolapse is very common and affects around 50% of women who have had a vaginal birth. It can also affect women who have not been pregnant or given birth. Additionally, some cancer treatments can have an impact on the pelvic tissue and pelvic floor muscles which can weaken the impact in this area and therefore increase the risk of prolapse.

An anterior wall prolapse (previously known as cystocele) is the most common prolapse. It occurs when the bladder pushes into the front wall of the vagina. This may cause difficulty in emptying the bladder which could cause infections. It may also cause an increase in urinary frequency (day or night), incontinence and difficulty in starting the flow of urine.

A posterior wall prolapse (previously known as rectocele) occurs when the rectum pushes into the back wall of the vagina. This may cause difficulty emptying or incomplete emptying of the bowels. It may also cause an increase in the sudden urge to empty your bowels or worsen constipation.

A uterine prolapse occurs when the womb moves down into the vagina due to lack of support. The cervix sits lower in the vagina. This may be noted when you have a smear test, but you may not be aware of the symptoms.

What are the signs and symptoms?

Not all prolapses are symptomatic; however, you might have experienced one or more of the following symptoms:

• Feeling of a bulge or heaviness into your vagina
• Lower back pain
• Urinary or bowel incontinence
• Difficulty emptying bladder or bowel
• Needing to pass urine more frequently
• Pain or discomfort during intercourse

Why have I got it?

Prolapse can be caused by several factors which affect the support system of the vagina. Some of the main factors that can contribute are:

• Pregnancy and childbirth
• Surgery impacting the muscles and nerves of the pelvis
• Treatments which lead to oestrogen deficiency
• Pelvic floor muscle weakness
• Obesity and being overweight
• Constipation – chronic straining
• Heavy lifting
• Family history
• Age
• Menopause and hormonal changes
• Chronic respiratory conditions
• Previous pelvic surgeries

What can I do about it?

Pelvic organ prolapse is not life threatening and with the correct management may improve. These are some of the options for management of your prolapse:

• Adopt good bladder and bowel habits and try to avoid constipation. For more information, visit our pelvic health page.
• Reduce heavy lifting where possible.
• Avoid long periods of standing or take short breaks if you are unable to avoid this.
• Maintain a healthy weight – we know that being overweight increases prolapse symptoms for multiple reasons. There are many resources on the NHS website for weight management. If you are struggling with this speak to your GP for further help.
• Improve your pelvic floor muscle function by completing pelvic floor exercises that focus on strengthening and relaxing your muscles
• Your GP may discuss other options with you such as a vaginal support pessary or oestrogen treatment, or refer you to a gynaecologist for further management

It may take between 6-12 weeks of consistent pelvic floor strengthening before you notice any improvement in your symptoms. This might seem like a long time; however, it is important you persevere as these exercises can make a significant difference to your symptoms.

Can I still exercise?

Yes. Exercise is important and appropriate exercise can improve your symptoms. Some activities are known to cause an increased pressure on your support systems including your pelvic floor.

If you are experiencing prolapse symptoms during a certain activity, it is advisable to modify this activity until your pelvic floor is strong enough to withstand the increased pressure. You should only continue with this activity once it no longer worsens your prolapse symptoms. These activities commonly increase the pressures:

• High impact exercise – for example jumping, running, HIIT. You could consider temporarily replacing these with swimming, cycling, Pilates, yoga, fast walking, or other low impact exercise.
• Heavy lifting – this could include carrying your food shopping home, lifting and carrying toddlers, long walks with a baby carrier on, or lifting weights in the gym.
• Think about reducing loads and modifying daily activities whilst you are improving pelvic floor strength. Sometimes lifting is unavoidable, in these instances try squeezing and holding your pelvic floor muscles through the lifting action.
• Finally, during any exercise it is important that you do not hold your breath. Try breathing out on exertion.