Dr Philippa Kaye: Prolapse

By Allison Hay

Shutterstock / Ground Picture © Woman in her sixties, smiling

Pic: Shutterstock / Ground Picture

A prolapse can cause all kinds of knock-on effects as Dr Philippa Kaye explains…

Dr Philippa Kaye

Sandra had been thinking about coming to see me for at least a year or so but had been putting things off.

She remembered that after the birth of each of her two children she would leak urine when she coughed or sneezed for a few months but did her pelvic floor exercises at the time and her symptoms improved.

She is now in her 60s and in the last year or so, although she hasn’t wet herself, she had been more aware of an urgent need to go to the toilet. When she needed to wee, she really had to go!

Prolapse symptoms

She came to see me though because of her bowels; she felt that she wasn’t fully opening her bowels as before. She had found what she called her “trick”, which was that she would put a finger inside her vagina when trying to open her bowels and if she pushed her finger backwards she felt she would go properly and feel “empty” afterwards.

When a friend mentioned a similar problem and Sandra mentioned her “trick” she also encouraged her friend to see her GP in case something else could be done, so Sandra thought she should follow her own advice!

Sandra had a prolapse, which is when one or sometimes more organs in the pelvis bulges down below the pelvic floor into the vagina. If it is only to a mild degree, you may not have any symptoms. A uterine, or womb, prolapse can lead to a dragging, or aching sensation in the vagina or pelvis, or pelvic pain. In more severe grades of prolapse, there may be tissue bulging out of the vagina itself.

Bladder and bowel problems

The bladder or bowel can also be affected. This can lead to or worsen symptoms of urinary urgency or incontinence. There can also be feelings of not having fully emptied your bladder or bowels. Just as Sandra describes, some women will insert a finger into the vagina and push a prolapse backwards in order to fully empty the bladder or bowel. A device called a Femmeze can be used instead of your finger. Other symptoms of prolapse include painful sex or recurrent urinary tract infections.

A prolapse can occur when the muscles of the pelvic floor become weak. After the menopause, the drop in oestrogen affects the pelvic floor which can become weaker and less elastic. The pelvic floor can also be affected by pregnancy, childbirth, chronic constipation and obesity. Without strong pelvic floor muscles and ligaments, the organs can sag down into the vagina and cause symptoms.

I discussed various factors with Sandra, including pelvic floor exercises and managing her constipation. She generally had to strain and push to open her bowels and only ever produced small pellets of poo. We discussed her diet, especially increasing her fluid intake and fibre, but that she should return if she was still constipated.

She started to sprinkle 1-2 tablespoons of linseeds onto her cereal or yogurt and her constipation improved. She was referred to a women’s health physiotherapist for further help with strengthening her pelvic floor.

When I last saw her, it was about something else entirely. She said that her symptoms had vanished, and yes, she was still doing her exercises and was not going to stop!

Treatment for prolapse

Treating any associated constipation can be helpful.
If you have obesity or are overweight then weight loss (which is difficult) can improve symptoms. However other treatment options are available irrespective of your weight.
Surgical options are available depending on type and severity.
Pelvic floor exercises and referral to a women’s health physio if appropriate.
A plastic pessary can be inserted into the vagina to help support the pelvic floor if surgery is not appropriate.

Advice given in this article and on the My Weekly website and magazines is not meant to replace personalised medical advice from your doctor. If you have any health concerns please see your doctor.

Article written on October 20, 2022; article reviewed and updated on May 24, 2024.

Each week we’ll ask Dr Philippa Kaye to talk about a prominent health issue, so look out for more articles in our health and wellbeing section in coming weeks. Read her advice on When To Bother Your Doctor, Allergies, Parkinson’s Disease, Shingles, Ovarian Cancer, Endometriosis, Long Covid and Ticks and Lyme Disease.