Uterovaginal prolapse: symptoms and treatment

The pelvic floor is a hammock of muscles and tissue that holds the womb, bladder and bowel in place. When it weakens, one or more of these organs can slip down and press into the vagina. Doctors call this pelvic organ prolapse.

Uterovaginal prolapse refers to descent of the womb along with the vaginal walls. Depending on which organs are involved, the same condition may be described as a bladder, womb or bowel prolapse. The NHS treats these together under pelvic organ prolapse, and the advice below follows that page.

The NHS says prolapse may not cause symptoms. When it does, women may notice a feeling of heaviness, discomfort or pressure in the lower tummy or vagina, a bulge or lump inside or coming out of the vagina, and pain, discomfort or numbness during sex.

Bowel and bladder changes are common. These can include constipation, a feeling that the bladder is not emptying fully, needing to pass urine more often, or leaking a little when you cough, sneeze or exercise. Sometimes prolapse is found only during tests done for another reason, such as cervical screening.

• See a GP if you have a lump in or around the vagina or any other symptom of prolapse.

• Mention bladder or bowel symptoms, because they often occur alongside prolapse.

• You can ask for a chaperone or a female doctor for the examination.

The NHS says prolapse can happen when the pelvic floor muscles weaken. It becomes more common with age, particularly after the menopause. Causes include pregnancy and childbirth, being overweight, long-term constipation and straining, persistent coughing, and pelvic surgery such as a hysterectomy.

Some conditions make prolapse more likely, including joint hypermobility syndrome, Marfan syndrome and the Ehlers-Danlos syndromes, which affect connective tissue. Several of these factors can add together over a lifetime.

A GP will ask about your symptoms and carry out an examination. You will need to undress from the waist down, and you may be examined lying on your side with your knees drawn up or standing. The doctor feels for lumps in the pelvic area and inside the vagina. A speculum may be used to see whether there is a prolapse.

If you have bladder problems, the NHS says the GP may refer you to hospital for further tests. NICE guideline NG123 includes recommendations on assessing pelvic organ prolapse in women, and on specialist services.

Treatment depends on which organs are affected and how severe the prolapse is. The doctor also considers your age, general health and any plans for future pregnancies. You and your doctor decide the best option together.

The NHS recommends keeping to a healthy weight, eating more fibre, drinking plenty of water and walking regularly to avoid constipation, and doing regular pelvic floor exercises. It suggests avoiding activities that put a lot of strain on the pelvic floor, such as heavy lifting, running and trampolining.

Stopping smoking also helps, because it makes a persistent cough less likely and a cough puts pressure on the pelvic floor. Prolapse itself is not usually dangerous, but untreated symptoms can interfere with sex, bladder control and daily activity.

The NHS says surgery using a supportive mesh inside the vagina is no longer done on the NHS unless there is no alternative. Women who had mesh previously and think it may be causing problems should speak to a GP or their surgeon. NICE NG123 also covers assessing and managing complications associated with mesh surgery.

The outlook varies. A mild prolapse may stay stable and need no treatment. Pessaries and physiotherapy can control symptoms for many women, and surgery is reserved for more severe cases. Charities such as Bladder and Bowel UK offer support and information.

The usual NHS route runs from GP examination to a women's health physiotherapist, a pessary clinic or a gynaecology or urogynaecology team. Surgical treatments are described by NHS England.

A private gynaecologist can offer faster assessment and the same range of options. Ask what type of prolapse you have, its grade, what each option involves, and what the surgical alternatives to mesh are.