Pelvic Organ Prolapse

Prolapse occurs when the supports of the vagina and pelvic organs fail, allowing the vaginal walls to sag, thereby creating vaginal bulge and pressure.

Prolapse can be managed with lifestyle modifications, a support pessary inserted vaginally or surgery to strengthen and reinforce the pelvic support structures.

Bladder dysfunction often accompanies pelvic organ prolapse.

Dr Dunn can also arrange urodynamics to investigate bladder leakage and urgency, to better establish the role for surgery in treating bladder dysfunction.

What is pelvic organ prolapse?

The pelvic floor is a set of muscles that form a hammock or sling around the opening of the pelvis. The pelvic organs, such as the womb (uterus), rectum and bladder, are held in position by the pelvic floor muscles and the surrounding tissues. When the pelvic floor muscles and connective tissues that support the pelvic organs are weakened, the pelvic support is lost, resulting in protrusion of the bladder, urethra, cervix, or rectum. This is called pelvic organ prolapse.

Women with pelvic organ prolapse may experience the following symptoms:

• a heavy dragging feeling in the vagina or lower back
• feeling of a lump in the vagina or outside the vagina
• urinary symptoms such as slow urinary stream, a feeling of incomplete bladder emptying, urinary frequency or urgent desire to pass urine, and urinary stress incontinence
• bowel symptoms, such as difficulty moving the bowel or a feeling of not emptying properly, or needing to press on the vaginal wall to empty the bowel
• discomfort during sexual intercourse

Dr Dunn will diagnose the condition by performing a pelvic examination. Ultrasound is rarely required to diagnose prolapse, but it may be used to identify if the pelvic floor (levator) muscles are detached.

If the symptoms are mild, non-surgical treatment options such as medications, pelvic floor exercises, vaginal pessaries (a device that is inserted in the vagina to support the pelvic floor), weight loss and lifestyle changes may be helpful.

Surgery can be considered in patients with severe symptoms of pelvic organ prolapse. There are different types of procedures to address a specific prolapse. The aim of pelvic floor reconstruction is to restore the normal anatomy and function of the pelvic organs. Vaginal mesh is no longer used in Australia for pelvic organ prolapse.

For more information on specific surgeries for pelvic organ prolapse, please view the following Patient Information Leaflets from the International Urogynacological Association:

• Treatment Options for Pelvic Organ Prolapse
• Pelvic Floor Physiotherapy
• Pessaries for Prolapse
• Low-Dose Vaginal Oestrogen
• Anterior Vaginal Repair
• Posterior Vaginal Repair
• Sacrospinous Fixation
• Vaginal Hysterectomy for Vaginal Prolapse