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What is a prolapse?

A prolapse is bulge from one part of the body to another.

More specificially, a vaginal prolapse is a bulge into the skin on the inside of the vagina. This is due to a weakness in the wall of the vagina. This weakness allows other organs of the pelvis (the bowel, bladder or uterus) to press into the skin of the vaginal wall, making it bulge inwards. If the prolapse gets large enough, it can bulge all the way out through the opening of the vagina.

What are the types of prolapse?

Prolapse are named depending on which part of the vaginal wall has the weakness. More than one type may happen at the same time. The four types are:

• Cystocele - the bladder bulges into the vagina
• Rectocele - the rectum bulges into the vagina
• Enterocele - the small bowel bulges into the vagina
• Uterine prolapse - the uterus drops down into the vagina.

More than one organ may bulge into the vagina at the same time.

What are the risk factors for a prolapse?

Some conditions make a prolapse more likey. They include:

• giving birth, particularly if the woman has had more than one baby
• being overweight
• repeated straining (pushing) on the toilet to pass hard bowel motions due to constipation
• having a chronic cough, e.g. from smoking or because of lung disease
• repeated heavy lifting, e.g. at work or the gym
• hormone changes after menopause (only for some women).

Small prolapses

In the early stages of a prolpse, the bulge may be so small it doesn't cause any symptoms or problems. The woman may not even know about the bulge until she is examined by a doctor.

Larger prolapses

Gradually, many prolapses increase in size and the bulge starts to cause problems and become visible as it sags down towards the outside of the vagina.

With a larger prolapse, the woman may experience:

• a heavy or 'dragging' feeling in the vagina
• a feeling of a lump in the vagina 'coming down'
• a visible lump poking out of the vagina
• sexual problems, such as pain during sex, or reduced feeling
• a bladder or bowel that doesn't empty properly
• a urinary tract infection (UTIs). For more information, go to Urinary tract infections.
• symptoms that are worse at the end of the day and get better after lying down
• a leaky bladder during coughing or sneezing (stress incontinence)
• wanting to go to the toilet more often, or feeling an urgent need to go (urge incontinence)
• bowel symptoms, such as constipation or faecal incontinence.

What treatments are available?

Where possible, treatment is aimed at simple lifestyle changes, such as:

• losing weight if the woman is overweight
• sitting on the toilet in the correct position. For more information, go to Correct toilet position.
• avoiding constipation and straining during a bowel motion
• learning pelvic floor muscle exercises
• giving up smoking or getting treatment for a chronic cough.

Pessaries and surgery

A pessary is a removable device put into the vagina to stop a prolapse bulging out. It's usually fitted by a gynaecologist or a continence nurse advisor. If the prolapse is severe, painful or making it hard to pass urine or faeces, the woman may need to have an operation to fix the problem.

For more information on prolapse, watch the video below.

Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.

Extra Resources

• Prolapse