The pelvic floor muscles are a series of muscles that form a sling or hammock across the opening of the pelvis. These muscles, together with their surrounding tissue, are responsible for keeping all the pelvic organs in place and functioning correctly. 

So what is pelvic floor prolapse?

When the muscles of the pelvic floor are damaged or weakened by overstretching, they are sometimes unable to support the weight of some or all of the pelvic organs. When this happens, one or more of the pelvic organs may drop below their normal positions, causing symptoms that range from mild discomfort to significant pain and disturbance of normal function.

Prolapse is relatively common after childbirth, hysterectomy and menopause. Although not life-threatening, it is a progressive condition which can cause physical discomfort and disfigurement and at times personal and social embarrassment through loss of bowel and bladder control.

What are the symptoms of pelvic floor prolapse?

The symptoms of pelvic floor prolapse depend on the type and severity of the prolapse. In mild conditions you may not be aware of any problems at all.

When prolapse is moderate or severe, symptoms may include:

• the sensation of a lump or dragging discomfort inside the vagina

• stress incontinence of urine

• frequent urine infections

• lower back pain

• constipation or incomplete emptying, obstructed defaecation

• pain or discomfort during sexual intercourse

• protrusion of the vagina and/or uterus from the vaginal opening

What are the causes of pelvic floor prolapse?

A number of things can increase your chance of developing pelvic floor prolapse, including:

• childbirth and pregnancy are the most common causes of the damage to the pelvic floor

• hysterectomy

• lowering of oestrogen levels due to menopause

• chronic constipation

• long term condition causing coughing and straining

• consistent heavy lifting

Preventing pelvic floor prolapse

As with any illness, prevention is better than treatment. 

This means appropriate antenatal care, careful management of the pelvic floor during labour and regular postnatal pelvic floor exercises (Kegel exercises) to reduce the risk of childbirth damage. We strongly encourage all women to learn to do Kegel exercises. Lifestyle changes such as losing weight and stop smoking can also be beneficial.

In post menopausal women oestrogen cream helps maintain tissue strength.

How is pelvic floor prolapse treated?

There are several ways to treat pelvic floor prolapse and these generally depend upon the type of prolapse and its severity. Mild degrees of cystocoele, rectocoele or uterine prolapse may not require any surgical treatment, especially if there is no discomfort.

Non surgical treatments include:

• Special exercises to strengthen pelvic floor muscles (Kegel exercises) can improve symptoms such as urinary stress incontinence and pelvic discomfort.

• Electromagnetic stimulation can be used to facilitate pelvic floor strengthening.

• Lifestyle changes, such as eliminating heavy lifting or treatment and suppression of a chronic cough, can halt the progression of pelvic prolapse.

• In menopausal women, oestrogen replacement therapy (combined with a progestin) can improve the strength of the pelvic floor ligaments and muscles, bringing an improvement in symptoms and increasing the effectiveness of Kegel exercises.

Where non-surgical measures are not enough to correct the problem, surgery to repair and reconstruct the weakened pelvic floor and restore normal function is the best option for treatment. There is a wide range of surgical procedures available. The best option depends on the nature of the prolapse.

Pelvic floor repair by laparoscopy is a comparatively new technique that enables surgeons to repair many of the pelvic floor conditions which are difficult to reach by other surgical methods. This approach also provides much better suspension of the vagina because the stitching of the vagina can be attached much higher up in the abdominal cavity than is possible when working from below in the vagina.

Laparoscopic techniques allow an excellent view of the pelvic floor and enable accurate identification of the pelvic floor defects. Laparoscopic surgery is less invasive than other procedures. It minimises the extent of vaginal repair, thus reducing the risk of painful internal scars.

As with all laparoscopic procedures, hospitalisation is comparatively short, pain is minimised and recovery is fast.

Synthetic polypropylene mesh materials are sometimes placed within the pelvic floor tissues replicating normal anatomy which realigns anatomical defects.

Your surgeon will advise on the appropriate procedure to correct the prolapse problem but in general patients can anticipate restoration of normal anatomy, correction of prolapse and treatment and relief from both urinary and faecal incontinence.