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Prolapse Management

Vaginal prolapse is common – over 50% of women over the age of 50 have some degree of prolapse but only 15-20% of women are symptomatic.

Symptoms commonly are:

  • Vaginal bulging: complaint of a ‘bulge’ or ‘something coming down’ through the vaginal introitus (opening). The woman may state that she can either feel the bulge by direct palpation, may be aware when having difficulty passing a bowel motion or may see the prolapse with a mirror.
  • Pelvic pressure: Complaint of increased heaviness or dragging in the supra-pubic area, perineum and/or pelvis.
  • Bleeding, discharge, infection: Complaint of vaginal bleeding, discharge or infection related to dependent ulceration of the prolapse.
  • Splinting/digitation: Complaint of the need to digitally replace the prolapse (push the prolapse up) or to otherwise apply manual pressure, e.g. to the vagina or perineum (splinting), or rectally (digitation) to assist voiding or defaecation.
  • Low backache: Complaint of low, sacral (or ‘period-like’) backache associated temporally with pelvic organ prolapse.
  • Other symptoms can include urinary hesitancy, slow urine stream, history of recurrent urinary tract infections, post-defaecation soiling.

Haylen et al 2010

I have written many blogs (articles) on prolapse and I recommend you read those blogs to improve your understanding of what a prolapse is. When you come to see the physiotherapists at our practice, you will be assessed and given a home programme to undertake and if there is significant prolapse the physiotherapist may suggest a trial of a pessary at the follow-up appointment in 3-4 weeks. The earlier you are aware that you have a small degree of prolapse, the sooner you can start the treatment strategies to prevent it getting worse.

Pelvic floor muscle training and learning the knack or bracing (tightening the pelvic floor muscles before increases in intra-abdominal pressure due to cough, sneeze, lifting, pushing heavy shopping trolleys, getting in and out of bed, going from sit to stand and bending then relaxing when the task is finished); understanding good bladder and bowel habits; learning the correct position for defaecation; and understanding the importance of pelvic floor friendly exercising will help treat vaginal prolapse and prevent it from worsening.

Pessaries of various forms such a ring, ring with platform, CPOP, cube and many others can all be helpful for vaginal prolapse. A pessary fitting is usually a month after the initial appointment when all the other strategies have been implemented by the patient. (The pessaries vary in price but start at $60 and range up to $120 -for a inflatoball- the cost of the pessary is on top of the pessary fitting price). All our physios fit pessaries. You need to make an hour and 15 minute appointment (dressed in a skirt or dress and joggers/walking shoes) so you can trial the different pessaries and find the one that does the best job of helping your prolapse. You will be taught how to self manage the pessary (put it in and out). It is important to get a speculum check and minual examination prior to your fitting if possible (otherwise immediately afterwards) and then every 12 months to ensure there is no erosion from the pessary. Please read the blog called The Forgotten Pessary as this one covers many of the possibilities that can happen with a pessary.


Ring  and ring with platform pessaries                                           Cube pessary


CPOP pessary