Our pelvic organs are held in place by ligaments and bands of tissue called fascia. Our pelvic floor muscles work cohesively with our pelvic tissues to provide support. As females go through different life stages, the strength of the pelvic floor can change. If the pelvic floor strength reduces it puts extra strain on the pelvic tissues and ligaments and they begin to stretch and one or some of the pelvic organs may start to drop down into the vagina.

So if we refer to the ship in the above diagram. Imagine:

• The ship = pelvic organs
• The rope that holds the ship to the moorings = pelvic ligaments and fascia
• Water level = pelvic floor

So when the water level is high, the amount of tension on the rope is sufficient enough to keep the boat from sinking. So in other words a strong pelvic floor will help the pelvic ligaments support the pelvic organs in place. When the water level is low, the rope supporting the ship is then is put on full tension, which places a lot of stress on the support system. Thus making the ship susceptible to moving. So in pelvic floor terms if the pelvic floor is weak, the ligaments have to take up the work of supporting the organs thus making us susceptible to prolapse.

The causes of prolapse will vary between individuals; it can occur suddenly or could gradually build up over time.

There are different types of prolapse, but also women can have a combination of prolapses. Thus symptoms will be different as well. Some women will have a prolapse but don’t have any symptoms at all.

Common causes of prolapse are:

• Pregnancy and delivering naturally with or without the assistance of certain devices such as forceps
• Occasions where there are repeated or frequent changes in pressures in the abdominal region such as constipation and straining, repetitive lifting
• Chronic coughing with asthma, smoking or any respiratory disease
• Menopause and age secondary to oestrogen level changes
• Previous gynaecological surgery in the abdominal area

A prolapse can present in a few different ways. You may notice:

• A sensation of heaviness or a dragging sensation in the pelvic area
• Or you are able to feel a lump in the vaginal area?
• A sense of incomplete emptying with the bladder or changing urine flow
• Incomplete emptying of the bowels or constipation
• Bladder or bowel urgency and/or incontinence
• Lower back ache

Our pelvic floor muscles provide support for our pelvic organs. Thus it is important that we strengthen and maintain the pelvic floor strength to be able to manage the symptoms. Pelvic floor physiotherapy could help give you an exercise program and provide advice to minimise the impact of prolapse. 

A pessary may also be considered as well. A pessary is a supportive device that is designed to lift and support the prolapse and is placed inside the vagina. There are a variety of different shapes and sizes of pessaries and it is important to know that one size doesn’t always fit all. A pessary could be an option to consider to either postpone surgery or instead of surgery.