Prolapse procedures

Prolapse happens when the muscles and tissues that support the vagina become weak. This allows the pelvic organs (such as the bladder, uterus, or rectum) to press against the vaginal wall, creating a bulge. Your healthcare provider may recommend a surgical or non-surgical treatment.

About prolapse

A prolapse is not life-threatening but it can cause discomfort, pressure, and changes in bladder or bowel function. It may also affect your physical activity and having sex. 

Non-surgical treatment

The non-surgical treatment option is a vaginal pessary. This is a small, removable device inserted into the vagina to support the weakened vaginal walls and help with prolapse symptoms.

Types of pessaries

  • Ring pessary – a flexible ring with or without support that can stay in place for months.
  • Gellhorn pessary – a more structured device with a flat disc and stem.
  • Cube pessary – a cube-shaped device that needs to be removed and cleaned daily.

Pessaries are made of soft silicone and are safe for long-term use. They are a good option if you want to delay or avoid surgery, especially if you plan to have more children or have other medical conditions that make surgery risky.

Surgical treatments

If a pessary does not work for you, your healthcare provider may recommend surgery to correct the prolapse. The type of surgery depends on which part of the vagina is affected.

You will need to take 6 weeks off work to recover from your surgery.
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An anterior wall prolapse happens when the bladder drops and pushes against the front of the vagina, creating a bulge. This is also called a cystocele.

Symptoms of an anterior wall prolapse

  • Feeling of heaviness or pressure in the vagina.
  • Bulge extending beyond the vaginal opening.
  • Difficulty emptying the bladder or a weak stream of wee.
  • Needing to wee often.

Surgery

An anterior wall repair strengthens the vaginal wall to support the bladder. Your surgeon:

  • makes a small cut in the front wall of the vagina
  • uses dissolvable stitches to tighten and reinforce the weakened tissue
  • closes the incision.

Recovery

You will need to stay in hospital for 1 to 2 days

A posterior wall prolapse happens when the rectum pushes against the back of the vagina, also called a rectocele or enterocele.

Symptoms of a posterior wall prolapse

  • Difficulty having a poo.
  • Feeling of fullness or pressure in your vagina.
  • Bulging tissue extending beyond the opening of the vagina.

Surgery

The surgeon:

  1. Makes a small cut in the back wall of the vagina.
  2. Uses dissolvable stitches to reinforce the tissue between the rectum and vagina.
  3. Coses the incision.

Sometimes, the perineum (the area between the vagina and anus) is also repaired to provide better support.

Recovery

You will need to stay in hospital for 1 to 2 days.

If the uterus has prolapsed, you may need to have a vaginal hysterectomy. This involves removing the uterus through the vagina to relieve symptoms and prevent further prolapse.

Causes of a uterus prolapse

  • Childbirth which can weaken the pelvic muscles.
  • Heavy lifting or straining - from constipation or coughing.
  • Being overweight (obesity).
  • Aging and genetic factors.

Recovery

  • You will need to stay in hospital for 2 to 3 days.

Sacrospinous fixation

This procedure is used to support the top of the vagina if it has prolapsed.

Surgery

  • The surgeon places stitches into a strong ligament inside the pelvis (the sacrospinous ligament) to hold the vagina or cervix in place.
  • These stitches either dissolve slowly or are replaced by scar tissue that provides long-term support.

This surgery is often combined with other prolapse repairs.

Recovery

You will need to stay in hospital for 2 to 3 days.

This is a procedure is done if you have had a hysterectomy and now have a vaginal vault prolapse (when the top of the vagina drops). A similar procedure, sacrohysteropexy, corrects uterine prolapse while keeping the uterus in place.

Surgery

  • The surgeon makes an incision in the abdomen (or uses keyhole surgery).
  • A special surgical mesh is attached to the top of the vagina to hold it in its normal position.
  • The mesh is secured to the sacrum (tailbone) and covered with tissue to prevent complications.

Recovery

You will need to stay in hospital for 2 days.

This procedure is used to support the top of the vagina if it has prolapsed.

Surgery

  • The surgeon places stitches into a strong ligament inside the pelvis (the sacrospinous ligament) to hold the vagina or cervix in place.
  • These stitches either dissolve slowly or are replaced by scar tissue that provides long-term support.
  • This surgery is often combined with other prolapse repairs.

Recovery

You will need to stay in hospital for 2 to 3 days.

Choosing the right treatment

The best treatment for prolapse depends on:

  • how severe your symptoms are
  • whether you plan to have more children
  • your overall health and medical history
  • your personal preferences.

Your healthcare provider will discuss your options and help you decide which approach is best for you.