Uterine (womb) prolapse: symptoms, treatment and pregnancy

RCOG explains that the organs in a woman's pelvis (uterus, bladder and rectum) are normally held in place by ligaments and muscles known as the pelvic floor. If these support structures are weakened by overstretching, the organs can bulge into the vagina. In uterine prolapse the uterus drops or sags down into the vagina and may eventually protrude outside the body.

RCOG says it is common to have more than one type of prolapse at once, and that prolapse is staged from 1 to 4 depending on how far down it comes. Women with stage 1 usually have mild or no symptoms and rarely need treatment.

The NHS says pelvic organ prolapse may not cause symptoms, but if it does they can include a feeling of heaviness, discomfort or pressure in your lower tummy or vagina, feeling or seeing a bulge or lump inside or coming out of your vagina, pain, discomfort or numbness during sex, problems pooing such as constipation, and problems peeing such as feeling your bladder is not emptying fully, needing to go more often, or leaking a small amount when you cough, sneeze or exercise.

Milton Keynes University Hospital adds that the lump is often smaller first thing in the morning and gets bigger during the day when you are on your feet, and that it can get in the way of sex or putting in tampons. RCOG says symptoms are often worse after standing for a long time and may improve on lying down.

The NHS says treatment depends on which organs have prolapsed and how severely, and takes your age, overall health and any plans for children into account. If you have no symptoms, or the prolapse is not bothering you, you may not need medical treatment. NICE says pelvic organ prolapse can be treated successfully using a range of treatments such as lifestyle changes and special exercises, with surgery usually considered if non-surgical treatments have not helped.

Yes, for symptoms. The NHS lists regular pelvic floor exercises among the things you can do yourself, alongside keeping to a healthy weight, eating more fibre and drinking plenty of water to avoid constipation, and avoiding activities that put a lot of strain on the pelvic floor, such as heavy lifting, running and trampolining. RCOG says that even if you are considering surgery it is advisable to continue pelvic floor training to improve your overall chances of successful treatment.

Milton Keynes University Hospital says pelvic floor exercises have no risk and are best taught by an expert, usually a physiotherapist.

RCOG says a pessary is a plastic or silicone device that fits into the vagina to support the pelvic organs, that it is suitable for most people, and that you may choose it if you are thinking about having children in the future, do not wish to have surgery, or have a medical condition that makes surgery riskier. You may also use one while waiting for surgery. Ring pessaries are most commonly used, and finding the right size may take more than one attempt.

Pessaries do not usually cause problems but can sometimes cause infection, discharge, bleeding or ulceration, and very rarely may get stuck, according to RCOG. It says it is possible to have sex with certain types in place.

RCOG says surgery for prolapse is usually performed through the vagina but may involve keyhole surgery or a cut in the abdomen. Options include pelvic floor repair, vaginal hysterectomy (removal of the womb, sometimes with a repair), operations that attach the womb or top of the vagina to ligaments or the spine using stitches or mesh, and colpocleisis, which closes the vagina and means vaginal intercourse is not possible.

Milton Keynes University Hospital says a vaginal hysterectomy is the most common operation for uterine prolapse and that it is not suitable for women who want more children. It lists risks including bleeding, infection, damage to the bladder (about 1 in 150) or bowel (about 1 in 2,500), and says about 1 in 3 women who have an operation for prolapse get another prolapse during their lifetime. After a vaginal hysterectomy the bladder becomes irritable or overactive in up to 15% of women.

The NHS says surgery to treat pelvic organ prolapse using supportive mesh is no longer done on the NHS unless there is no alternative. RCOG advises avoiding heavy lifting and sexual intercourse for 6 to 8 weeks after surgery.

Milton Keynes University Hospital says that if you have not been through the menopause and might want more children, it may be better to do nothing or use a pessary until your family is complete. It says the prolapse lump may get worse during pregnancy and not improve once the baby has been born, that having a prolapse does not usually stop you from having a normal delivery, and that some types of pessary can be used in pregnancy.

RCOG says that if you plan to have children you may be advised to delay surgery until your family is complete, because another pregnancy and birth may increase the chance of the prolapse happening again. The NHS lists pregnancy and childbirth among the causes of pelvic organ prolapse.

The NHS says prolapse can happen when the pelvic floor muscles weaken, and that it is more common as you get older, particularly after the menopause. It lists pregnancy and childbirth, being overweight, long-term constipation and straining, persistent coughing and pelvic surgery such as a hysterectomy. Joint hypermobility syndrome, Marfan syndrome and Ehlers-Danlos syndromes can also make a prolapse more likely.

RCOG adds that ageing, persistent heavy lifting and a natural tendency to develop prolapse can contribute, and that often it is a combination of factors.

The NHS says to see a GP if you have a lump in or around your vagina or any other symptoms of pelvic organ prolapse. The GP will ask about your symptoms and examine you, and you can ask for a chaperone or a female doctor. RCOG says prolapse is diagnosed by an internal examination, and that you will be offered a urine test to check for infection.

Milton Keynes University Hospital says that if a prolapse permanently protrudes and is exposed to the air, it may dry out and eventually ulcerate, so it is probably best to push it back with a ring pessary or have it repaired, even without symptoms.

On the NHS, a GP can examine you, refer you to a women's health physiotherapist and arrange pessary fitting, with gynaecology or urogynaecology referral if surgery is being considered. Some people choose private gynaecology for faster access to assessment. NICE suggests asking about the benefits and risks of each option, including mesh, and being clear about what matters most to you, for example plans for a future pregnancy.