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A prolapse (POP) is a bulge within the vagina – this can be the front or back wall of the vagina, or the uterus (womb). It can be a combination of any of these. It is very common – 1 in 3 women who have had children may have a degree of pelvic organ prolapse.
What are the symptoms?
• A feeling of ‘something coming down’ or a heavy, dragging sensation in the vagina, which may be worse at the end of the day.
• A bulge may be seen or felt inside or outside the vagina.
• Difficulty in emptying the bladder, and repeated urinary tract infections
• A change in bladder frequency or bladder leakage.
• Difficulty emptying the bowel
• Difficulty using tampons
• Discomfort during intercourse
Why does it happen?
The pelvic organs are supported in the pelvis by ligaments and the group of muscles which make up the pelvic floor. These can become weakened by:
• Pregnancy and childbirth
• Being overweight or obese
• Straining regularly to open your bowels (constipation)
• Repeated heavy lifting
• Age and menopausal changes
• Chronic cough caused by smoking, asthma, or other lung disease.
• Decreased general fitness
• Previous gynaecological surgery
• Maternal family history
Strengthening the pelvic floor muscles will help to support the pelvic organs and make the symptoms of prolapse less bothersome.
How to exercise the pelvic floor muscles
Start by sitting in a comfortable position, with your feet flat on the floor. Imagine that you are trying to stop yourself passing urine or ‘wind’, by drawing the area from bowel to bladder
‘upwards and forwards’ – then let go. Like a ‘squeezing and lifting’ movement.
• Try and hold for 5 seconds, then let go.
• Repeat this 5 times.
This is a ‘slow’ squeeze. Now tighten the pelvic floor muscles quickly 5 times, with a little rest between each contraction, making sure you relax the muscle fully between each ‘squeeze and lift’. This is a ‘quick’ contraction. The slow squeezes help to build up endurance in the pelvic floor to support the organs in the pelvis and also help you to ‘hold on’ for longer! The quick squeezes help your pelvic floor to react quickly when you cough or sneeze. Remember not to hold your breath and keep your buttocks and thighs relaxed. Make sure the muscles relax fully between each squeeze.
How often do you need to do pelvic floor exercises?
• Try 5 slow hold squeezes, followed by 5 quick squeezes, at least 3 times a day.
• As your muscles get stronger, try holding the slow contractions for longer, to a maximum of 10 seconds.
You can gradually increase the number of pelvic floor squeezes to a maximum of 10 ‘slow’ and 10 ‘quick’ squeezes (don’t overtire the muscles).
• It can be hard to remember to do these exercises routinely.
Try to think of a good time in your day to do them so it becomes habit! Don’t try to stop and start your flow of urine whilst on the toilet – this can interfere with normal bladder function.
Lift and squeeze the pelvic floor muscles before activities which could increase your prolapse symptoms, such as coughing, sneezing or lifting.
What else can you do to help your symptoms?
• It may help to lean forward or rock your pelvis when emptying the bladder to make sure you are emptying fully.
• Avoid heavy lifting where possible
• Avoid constipation by drinking enough 1.5 – 2 litres a day), and eating a healthy diet which includes fruit, vegetables and wholegrains. Take regular exercise (just walking can help)
• Use a good position to make it easier to empty your bowels – put your feet on a small step, keep your tummy relaxed, and avoid straining – See ‘Tips for healthy bowels’ information leaflet.
• It may help to support the perineum (the area just in front of the back passage) when emptying the bowels.
• Choose low impact exercise, rather than high impact or lifting weights – Pilates, swimming, cycling, fast walking, cross-trainer, modified aerobics.
These can all help improve or maintain your fitness without aggravating your symptoms.
• Try to lose weight if you are overweight.
• Try to avoid standing for long periods of time.
• See your GP if you have a chronic cough or would like help to give up smoking.
You can download the NHS approved ‘Squeezy’ app to your phone or tablet to help you with your pelvic floor exercises. A more detailed leaflet about Prolapse is available at
https://thepogp.co.uk/patient_information/womens_health/vaginal_prolapse.aspx and further pelvic floor advice including audio clip at