Pelvic Organ Prolapse
Restoring Support & Confidence
Pelvic Organ Prolapse (POP) is a condition that affects nearly 50% of women who have given birth, yet it remains one of the least discussed issues in women’s health. Many women experience a sensation of "heaviness" or a physical bulge and feel that it is simply an inevitable part of aging or motherhood. I am here to tell you that it is not. Prolapse is a highly treatable medical condition, and you do not have to live with the discomfort or the impact it has on your daily activities.
As a gynaecological surgeon, my goal is to help you understand why your support structures have changed and to offer a range of solutions—from specialized physiotherapy to advanced reconstructive surgery—that can restore your comfort and your quality of life.
What is Pelvic Organ Prolapse?
Think of your pelvic floor as a "hammock" made of muscles and connective tissues (ligaments). This hammock supports your pelvic organs: the bladder, the uterus, and the rectum. When these supports become weakened, stretched, or damaged, one or more of these organs can descend from their normal position and press into the vaginal walls.
Understanding the Different Types
Prolapse is categorized by which organ is involved:
Cystocele (Bladder Prolapse): The most common type, where the bladder bulges into the front wall of the vagina.
Rectocele (Bowel Prolapse): The rectum bulges into the back wall of the vagina, often making it difficult to empty the bowels.
Uterine Prolapse: The uterus descends into the vaginal canal.
Vaginal Vault Prolapse: Occurs in women who have had a hysterectomy, where the top of the vagina drops down.
Recognising the Symptoms
Many women have mild prolapse with no symptoms. However, as the prolapse progresses, you may notice:
The "Bulge": Feeling or seeing a lump at or protruding from the vaginal opening.
Pelvic Heaviness: A dragging sensation or "pressure" that often feels worse at the end of a long day or after exercise.
Urinary Changes: Difficulty starting your stream, a feeling that your bladder isn't empty, or "stress incontinence" (leaking when you cough, sneeze, or jump).
Bowel Issues: Difficulty passing stool, which may require you to "splint" (apply pressure to the vaginal wall) to help the bowel empty.
Why Does Prolapse Happen?
The weakening of the pelvic floor is usually the result of multiple factors over a long period:
Pregnancy and Childbirth: The pressure of pregnancy and the stretching of the pelvic floor during vaginal delivery are primary factors.
Menopause: The decline in oestrogen leads to thinner, less elastic tissues in the pelvic area, making prolapse more likely to occur later in life.
Chronic Strain: Long-term constipation (straining to go), chronic coughing (from smoking or asthma), or heavy lifting (at work or in the gym).
Genetics: Some women are born with naturally weaker connective tissue.
Exploring Your Treatment Options
We have moved far beyond the era where surgery was the only option for prolapse. Management is now highly individualized:
Pelvic Floor Physiotherapy: For mild to moderate prolapse, working with a specialized women's health physiotherapist can strengthen the "hammock" and significantly reduce symptoms.
Vaginal Pessaries: These are soft, removable silicone devices (similar to a diaphragm) that are inserted into the vagina to provide internal support. They are an excellent non-surgical solution that can be used long-term or just during exercise.
Vaginal Oestrogen: Improving the health of the vaginal tissue can often make symptoms more manageable.
Reconstructive Surgery: If conservative measures are not enough, specialised surgeries can be performed to repair the support. This can include Native Tissue Repair (using your own tissue to reinforce the walls) or Laparoscopic Sacrocolpopexy (using keyhole surgery to support the top of the vagina).
Management: The Gold Standard
While there is no "cure" for Lichen Sclerosus, it is highly manageable with the right treatment plan.
Ultra-Potent Topical Steroids: The "gold standard" of treatment. When used correctly—starting with an intensive phase and moving to a maintenance "pulse" therapy—steroid ointments can put the disease into remission, heal the skin, and prevent future scarring.
Emollients: Using soap-free washes and thick barrier creams (like plain paraffin) to protect the skin from irritants like urine and sweat.
Lifestyle Adjustments: Wearing loose, cotton underwear, avoiding scented products, and using specialized lubricants for intimacy.
Frequently Asked Questions about Pelvic Organ Prolapse
Q: Will a prolapse get worse if I don't have surgery?
A: Not necessarily. Many prolapses stay at the same stage for years. Lifestyle changes and pelvic floor therapy can often manage symptoms and prevent progression. Surgery is usually reserved for when the prolapse significantly impacts your daily life.
Q: Can I still exercise with a prolapse?
A: Yes! Exercise is vital for health. However, you may need to switch to "low impact" activities like swimming or cycling and avoid heavy lifting or high-impact running if they make your symptoms worse.
Expert Surgical & Individualised Care
As a highly qualified gynaecological surgeon, I understand that Pelvic Organ Prolapse is more than just a physical issue; it is a quality-of-life issue. I provide a safe, supportive environment where we can discuss your symptoms without embarrassment. I listen to how the prolapse is affecting your exercise, your bowel habits, and your intimacy. My approach is entirely individualized; we work together to find the right balance of medical, mechanical, and surgical options. I can help you restore your confidence and help you return to the activities you love.