Vaginal Prolapse
What is Prolapse?
Pelvic organ prolapse is a common condition where the walls of the vagina start to
collapse and fall inwards. This leaflet explains the different types of prolapse that can
occur and provides information about causes, diagnosis, treatment options and
prevention, as well as what you can do to help ease your symptoms. Prolapse may be
found in up to half of women, who have had children, but not all will have symptoms and
it is more common among older women.
The weakness can happen for a variety of reasons:
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Chronic constipation

Surgery
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Persistent coughing
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Occupation

Childbirth

Menopause

The natural ageing process

Being Overweight
What kind of problems can a prolapse cause?



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A feeling of “Something coming down” - the most common symptom is a bulge in the
vagina which can cause discomfort.
Bladder problems - prolapse may be associated with urinary incontinence or going to
the toilet more frequently.
Bowel problems - prolapse may lead to difficulty emptying the rectum (back passage).
Common symptoms include having to push the lump back and difficulty in getting
clean after a bowel motion.
Sexual intercourse problems – a prolapse may get in the way during sexual
intercourse and cause pain/discomfort.
Types of Prolapse
Pelvic organ prolapse occurs when the support of the pelvic organs begins to weaken.
This may result in a number of different prolapses.

Prolapse of the Front (Anterior)
Vaginal Wall

Uterine and Vaginal Vault Prolapse (Top of the vagina)

Prolapse of the Back (Posterior)
Vaginal Wall
When the front or back wall of the vagina prolapses, the organ behind it (the bladder or
bowel) usually follows it down and adds to the bulge. The womb (uterus) can lose its
support and descend into the vagina. The top of the vagina can also prolapse if you have
had a hysterectomy, called a vault prolapse. Whilst prolapse is not life-threatening it can
cause a great deal of discomfort and distress.
All prolapses are graded according to their severity
 Grade 1: the uterus or vaginal walls have dropped slightly. At this stage many women
may not be aware they have a prolapse. It may not cause any symptoms and is
usually diagnosed as a result of an examination for a separate health issue.
 Grade 2: the uterus or vaginal walls have dropped further into the vagina and the
bulge can be seen at the vaginal opening.
 Grade 3: most of the uterus or vaginal wall has fallen through the vaginal opening.
Treatment of Prolapse
There are four options for treating prolapse
1. Do nothing, if the prolapse is not causing any interference with daily life. However
avoiding heavy lifting or prolonged standing will reduce the symptoms.
2. Physiotherapy may help with the use of pelvic floor exercises, techniques and
equipment aimed at stimulating and strengthening the pelvic floor muscles which
would aim to relieve any discomfort and in mild cases possibly “cure” the prolapse.
See below for further information about pelvic floor exercises.
3. The use of a mechanical device called a pessary. This is used to “hold up” the
prolapse and reduce the symptoms. The pessaries do not cure prolapse but just
control the prolapse whilst the pessary is in place. There are a variety of pessaries
available, but the most commonly used one is the ring pessary.
4. Finally, surgery - The most common surgery for prolapse is a pelvic floor repair.
This is a term used to describe basic repairs to the pelvic floor. More specifically,
the term anterior repair refers to correction of the front wall of the vagina; and
posterior repair, to correction of the back wall of the vagina. If the uterus is
prolapsing, then it can be removed with a hysterectomy. If you have already had a
hysterectomy, then the top of the vagina can be re-suspended. (See our other
leaflets for more details.)
Pelvic Floor Exercises
The pelvic floor muscles are layers of muscle located in the base of your pelvis like a
hammock. They are attached at the front, to the pubic bone, and at the back, to the base
of the spine around the sacrum and coccyx (tailbone).
Imagine you don’t want to pass wind or urine. Tighten and pull up the muscles around
and inside your back passage (anus) and vagina, without squeezing your buttocks, or
pulling in your abdomen.
Imagine your vagina is a lift shaft with the opening representing the ground floor and the
belly button representing the top floor. Slowly lift and squeeze the muscles from the
ground floor to the top floor and hold it there. Try to breathe while you continue to hold
the contraction.
There are two ways in which you need to work the pelvic floor muscles.
The first exercise works on the holding ability of the muscles
1) Slowly tighten, lift and draw up the pelvic floor muscles. At first you may find this is
almost impossible to do. Don’t worry, just try and hold this squeeze for one or two
seconds. You will soon get better at it. Rest for at least 10 seconds between each
squeeze and try and repeat the squeeze up to 10 times.
The second exercise works the muscles that quickly shut off the flow of urine to help
prevent accidents.
2) This is a brisk, snatching-type contraction. Quickly tighten, lift up and then fully relax.
Make sure you completely relax before you do the next snatch. Make this exercise a
clean, brisk movement (not a sluggish squeeze).
Don’t try to do too many exercises at first. Quality is better than quantity. However, to
strengthen the muscles and improve their function, the pelvic floor muscles must be
challenged to work harder than they are used to and on a regular basis too. Be
committed and you will reap the rewards, possibly in a matter of weeks
What is a Pessary?
A Vaginal Pessary is a device which is inserted into the
vagina to hold a prolapsed vaginal wall or uterus in place.
Pessaries are made of Silicone or Vinyl. There are a
variety of types but the two different types of pessary that
we use most commonly are ring and shelf pessaries.
Vaginal pessaries are used by women who prefer nonsurgical treatment, when childbearing is not completed or
where surgery may not be a safe option due to health
problems.
Ring Pessary - is round in shape and comes in different sizes. The
size you need will be assessed by a healthcare professional. They
are used for patients who have a prolapse where the womb is
coming down the vagina and they can be used for other types of
prolapse.
Falk Pessary - is similar to the ring pessary but supports a
prolapsing uterus more effectively than a ring pessary. It is also
used for prolapse of the front wall of the vagina.
Shelf Pessary - a hard plastic device used for patients who need to
have extra support for their womb/vagina or those in whom the ring
pessary does not stay in. However it is not suitable for women who
are still sexually active due to the shape and position of the pessary.
Fitting of the Pessary
Following discussion with the doctor about the best treatment for your vaginal prolapse, a
pessary may be advised, which will be fitted at the consultation. Pessaries may not be
suitable for everyone, as every prolapse is different and vaginas are all different shapes
and sizes. There is no easy way to measure the vagina. Pessaries are fitted by
estimating the size required and either increasing or decreasing the size if it is
uncomfortable or falls out. If the ring continues to be uncomfortable or keeps falling out
then, an alternative pessary may be needed, or another option of treatment discussed.
What will happen during follow up appointments?
You will be asked some questions about your satisfaction with the pessary since the
previous appointment. You will be asked if you have had any problems with bleeding,
discharge, urinary problems, bowel problems or discomfort and also if you have had any
new symptoms from the prolapse.
With your consent the ring pessary inserted at the previous appointment will be gently
removed by inserting a well lubricated finger into your vagina. A speculum will then be
inserted into the vagina so that the vaginal walls can be examined for any abnormalities,
such as infection or ulcerated areas. If there are no problems a new pessary will be
inserted using a lubricant or oestrogen cream.
What are the risks?
Risks During Changing a Pessary
You may feel some discomfort on removal/insertion of the ring but any pain would be
brief and temporary.
You may experience some bleeding immediately after the pessary is changed so do not
be worried by this.
Several attempts may be needed to make sure you have the most appropriate pessary in
the correct size. You should be able to pass urine without the pessary falling out and be
comfortable when you leave the clinic
Long Term Risks
• Ulceration of the vagina – This may give you abnormal bleeding or discharge and you
should see your doctor. Simply removing the pessary for a few weeks and using some
oestrogen cream in the vagina at night will often cure the problem. If it persists then you
will be given a further hospital appointment for review.
• Infection – If there is vaginal discharge a vaginal swab will be taken. The results will be
reviewed. If treatment is required both you and your GP will be contacted so that
treatment can be started. A pessary will not be replaced, unless requested by you, until
the results are available and appropriate treatment given if necessary. A further
appointment will be made for 8 weeks.
• Bleeding – If you report any bleeding, the ring will not be replaced and an appointment
will be made for you to have a pelvic ultrasound. You will be reviewed by your Consultant
in 2 weeks to discuss the results. Your ring may be replaced on the advice of your
Consultant, depending on the results.
• The ring falls out – Rings are fitted by gauging the size required. If the ring is too small
it may fall out on passing urine or opening your bowels. This is nothing to worry about; it
just means fitting a different size. If the ring is too big it may be uncomfortable. If the ring
continues to fall out or be uncomfortable, an appointment will be made for you to see the
Consultant.
What happens after fitting a pessary?
Once the pessary is inserted and placed appropriately in the vagina, it needs to be
changed every 4-6 months. It may be required to change the pessary more frequently if
there is recurrent ulceration of the vaginal wall. It is important to attend your next
appointment to prevent complications occurring. You will be asked to move around, sit
down and pass urine before you leave the department to ensure that the pessary is
comfortable.
It is possible to have sexual intercourse with the ring pessary in place, although your
partner may feel the pessary and you may have to experiment with different positions to
find the most comfortable. If you have a shelf pessary it is not possible to have sexual
intercourse, this is because of the shape of the pessary. This type of pessary will not be
offered if you are sexually active.
If you experience any pain or an offensive discharge, you should contact your GP. You
may be advised to use vaginal oestrogen treatment once/twice per week to alleviate
vaginal dryness and help the process of changing the pessary.
If you have any problems, you can contact the Urogynaecology secretary on 01733
673766