Pelvic organ prolapse

Information for women, their partners and families about symptoms and management of prolapse experienced during and after the menopause

Prolapse problems after the menopause

The organs within a woman’s pelvis (uterus, bladder and rectum) are normally held in place by ligaments and muscles known as the pelvic floor. If these are weakened, the pelvic organs can bulge (prolapse) from their natural position into the vagina. This is known as pelvic organ prolapse. This can sometimes happen at the time of the menopause due to the decrease in estrogen.

While prolapse is not considered a life-threatening condition, and some women can have a prolapse without having any symptoms at all, it may cause a great deal of discomfort and distress. Common symptoms can include:

• A feeling of dragging or heaviness in the pelvic area
• A bulge in the front or back wall of the vagina - sometimes, this bulging may extend outside the vagina
• Difficulties with continence - bladder or bowel, depending on the location of the prolapse
• Discomfort and lack of sensation during sex

You should see your doctor if you have one or more of these symptoms.

Find out more about pelvic organ prolapse

The links below provide more information about pelvic organ prolapse:

• Pelvic organ prolapse (RCOG)
  Includes information about the different types of prolapse, symptoms and options for treatment
• Prolapse: uterine and vaginal (Women’s Health Concern)
  Factsheet giving an overview of causes, symptoms and treatment
• Pelvic organ prolapse (NHS)
  Overview of types of prolapse, diagnosis and treatment

You may also find useful information on the following websites:

• Bladder Matters
• Bladder and Bowel Community

Treatment and management of pelvic organ prolapse

Non-surgical options

Non-surgical options can be an effective way of managing symptoms, and include:

• Pelvic floor muscle training (Kegel exercises)
• Vaginal hormone treatment (estrogen) - if you have gone through the menopause, your doctor may recommend vaginal estrogen treatment in the form of tablets, cream or a ring
• Vaginal pessaries - plastic or silicone devices that fit into your vagina to help support the pelvic organs

The links below provide more information about surgical procedures:

• Pelvic floor exercises (NHS)
  Introduction to pelvic floor exercises
• Pelvic floor exercises (British Association of Urological Surgeons)
  Answers to FAQs about pelvic floor exercises
• Treating pelvic organ prolapse (NHS)
  Overview of different treatment options

Surgical procedures

Your healthcare practitioner may recommend a surgical procedure to treat and manage your prolapse condition. A number of different procedures may be offered, including:

• A pelvic floor repair - the vagina walls are tightened to support the pelvic organs
• Vaginal hysterectomy, or removal of the womb, may be suggested - this is sometimes done at the same time as a pelvic floor repair
• Sacrocolpopexy or sacrospinous fixation - the top of the vagina is attached to a bone or ligament

Some operations involve the use of mesh or tape - see below for more information.

You may be offered a number of different surgical procedures. The links below provide information about the various options:

• Treatment of pelvic organ prolapse (NHS)
  Overview of the different surgical procedures used to treat prolapse
• Pelvic floor repair operation (RCOG)
  Overview of pelvic floor repair
• Sacrocolpepexy for vault prolapse (British Society of Urogynaecology)
  What to expect from sacrocolpepexy surgery for treating prolapse
• Vaginal hysterectomy for uterine prolapse (British Society of Urogynaecology)
  What to expect from vaginal hysterectomy for treating prolapse
• Posterior vaginal wall prolapse repair without the use of mesh (British Society of Urogynaecology)
  What to expect from posterior vaginal wall prolapse repair and repair of the perineum
• Anterior vaginal wall prolapse repair operation without the use of mesh (British Society of Urogynaecology)
  What expect from an operation for anterior vaginal wall prolapse
• Prolapse of the vaginal apex operations (South Tees Hospitals NHS Foundation Trust)
  Information about treating prolapse of the vaginal apex
• Sacrohysteropexy for uterine prolapse (British Society of Urogynaecology)
  Sacrohysteropexy for treating vaginal vault prolapse
• NICE patient decision aid on Surgery for uterine prolapse

As with all decisions about your treatment and care, it is important that you discuss all of the options with your healthcare team, including the risks and benefits of each option.

Mesh and tape

Please see our mesh page, which brings together a range of resources and information to help women make informed choices about their care. Since December 2017, the National Institute for Health and Care Excellence (NICE) recommends that mesh should only be used for the treatment of pelvic organ prolapse under research circumstances. If you join a research study, NICE recommends that you are regularly monitored for any complications. If you have had vaginal mesh inserted and think you are experiencing complications, or you want to find out about the risks involved, speak to your GP. You can also report a problem with a medicine or medical device on GOV.UK. 

In a number of operations for pelvic organ prolapse, mesh or tape (supporting material) is used to provide additional support to tissues. It is currently recommended that operations using mesh are only performed by specialists with expertise in this technique and only after a full discussion about the benefits and risks of such surgery with the woman.

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