Double Prolapse
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Double Prolapse
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If you have been diagnosed with or think you may have a prolapse, you can find out about the different types of treatments that may be offered to you here, as well as ways of helping yourself. This information should be used in conjunction with support from your GP or health professional to help you find the right course of treatment best suited to your individual needs; enabling you to manage your condition and improve your quality of life.
Please use this information carefully and always speak to your GP or health professional, they can explain what is causing your problem and how the different treatments may help you. They will also talk to you about any side effects, these are extra problems that can be caused by the treatment.
Together, you can decide which treatment is the most suitable.
There are four options to consider:
Sometimes the operation you have for prolapse will change from the original plan, either because of what assessment the doctor does at the beginning of surgery to consider what is prolapsing and how much or difficulties experienced during the operation. In this case, your doctor will do what he or she thinks is best for you at that time.
If a mesh or extra tissue is used in a prolapse operation, there is a risk that the mesh can get infected, though antibiotics are given in theatre and for a period of time after surgery to prevent this, or the mesh can cut through (erode) the surrounding tissue. This may require a further operation to remove part of the mesh or repair any damage.
About a third of women who have prolapse surgery need more than one operation because there is a 25-30% chance the prolapse can return or a different type of prolapse develops. For example, a prolapse of the womb can occur after an operation for prolapse of the vagina and vice versa.
Prolapse surgery usually improves or cures the symptom of ‘something coming down below’ or the lump in the vagina. Symptoms that relate to bladder and bowel problems, including constipation or incontinence, are not always improved. Similarly, problems with your sex life may not be improved with surgery.
In some cases, some new bowel or bladder symptoms develop after prolapse surgery, which may require further treatment in the future, including further surgery. Some women develop incontinence after prolapse surgery and some have problems emptying their bladder and need to use a catheter afterwards. This problem usually gets better with time. There is a small risk of venous thrombosis (clots forming in your legs and lungs) with any pelvic surgery. To reduce this risk you will be given an injection every day and some anti-embolic stockings to wear.
How long will it take to recover? Many women have a vaginal pack (ribbon gauze material) inserted at the end of a prolapse operation, to prevent bleeding. A urinary catheter is also used to rest the bladder immediately following the operation. Both of these are usually removed the day after surgery.
It is likely that you will be in the hospital for 2-3 days depending on the type of prolapse operation and any medical conditions you have. Following this the recuperation period is 2 -3 months and you must avoid heavy lifting and stretching for three months.
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You are here: Home / Prolapse / How Severe is Your Prolapse? Understanding Your Prolapse Diagnosis
How severe is your prolapse diagnosis?
Are you worried you may need prolapse surgery?
Is your prolapse beyond repair without surgery? It‘s often confusing to understand your prolapse severity – especially if you’re feeling nervous and disappointed when receiving your diagnosis.
You can’t really see the full extent of your prolapse and it’s a little socially awkward to compare it to someone else’s.
The following Pelvic Floor Physiotherapist information is designed to help you understand your prolapse diagnosis:
International best selling prolapse exercise guide for women with prolapse and after prolapse surgery.
Prolapse Exercises teaches you how to:
Your prolapse symptoms may feel awful but this doesn’t necessarily mean your prolapse is severe! Typical prolapse symptoms such as pelvic heaviness or lower back pain don’t correspond with prolapse severity. 1
Some women are quite surprised to learn they have a prolapse during their regular pap smear. Others report quite bothersome symptoms with relatively minor prolapse severity.
Some prolapse symptoms tend to worsen in women with more severe prolapse. Vaginal bulging and being able to see your prolapse at the entrance of your vagina are prolapse symptoms that often worsen with more advanced prolapse. In other words you may or may not necessarily experience some of the established troublesome bowel, bladder or prolapse symptoms with different degrees of prolapse severity.
There is however a trend for some specific and bothersome prolapse symptoms to worsen in women with more advanced or severe prolapse.
Your doctor may have given you a prolapse diagnosis of mild, moderate or severe prolapse.
This is a very simple and general diagnosis of prolapse severity usually based on how troublesome your prolapse symptoms are and the amount of downward movement of your prolapse within your vagina evident during your examination. A big problem with this type of general assessment is that it’s not scientifically accurate or exact.
An accurate prolapse diagnosis must fully reproduce the full extent of the downward movement of your prolapse during your internal examination. This is why your doctor or physiotherapist will ask you to cough and strain downwards during your examination.
Most women need to be examined standing upright to fully reproduce the full extent of prolapse and provide them with an accurate prolapse diagnosis.
The POP-Q 3 or Pelvic Organ Quantification is the internationally recommended prolapse classification system that was introduced to improve the accuracy of measuring prolapse severity. This system allows your health practitioner to provide a more accurate prolapse diagnosis than a general assessment.
If your gynaecologist uses POP-Q he or she will measure how far your prolapse moves downward within and/or out of your vagina by looking at the leading edge or the lowest part of your prolapse and measuring how far this moves downwards with coughing and bearing down or straining. Using this system your gynaecologist may have told you that your prolapse is somewhere on the range of Stage 0 to 4.
If your gynaecologist has used POP-Q to measure, he or she will classify your prolapse as follows:
Stage 0 – no prolapse is demonstrated during your examination
Stage 1 – the lowest part of your prolapse is more than 1 cm above your *hymenal ring
Stage 2 – the lowest part of your prolapse is within 1 cm either side of your hymenal ring
Stage 3 – the lowest part of the prolapse is more than 1 cm below the hymen but the vagina has not completely prolapsed
Stage 4 – the vagina is completely prolapsed outwards.
Prolapse severity is measured using the hymenal ring as a fixed reference point in POP-Q assessment. The hymenal ring sits approximately 1cm within the external entrance or opening to the vagina. When the hymen (thin tissue across the entrance to the vagina) is broken by penetrative intercourse or using tampons the hymenal ring is the level where the hymen was previously positioned.
Some gynaecologists still diagnose a uterine prolapse as first, second or third degree in severity.
This system was used in the past to grade uterine prolapse by assessing how far the cervix had moved downwards in the vagina. The cervix is the muscular ring (feels like a nose tip) that sits at the very top of your vagina at the entrance of your uterus.
Recent research 2 has shown that some women with mild to moderate prolapse (i.e. Stages 1- 2 as measured by POP-Q method), supervised pelvic floor muscle training including home pelvic floor exercises decreased prolapse severity and reduced specific prolapse symptoms.
This means that for women with mild to moderate prolapse (i.e. prolapse above the hymen) it may be possible to reduce prolapse symptoms and even avoid prolapse surgery with pelvic floor muscle training .
A lack of research means that it is currently unknown whether women with more severe prolapse diagnosis can reverse prolapse symptoms and severity with exercises.
Some women with more advanced or severe prolapse will require prolapse surgery or long-term support pessary management. The most appropriate time for you to proceed with prolapse surgery is a matter for you and your gynaecologist to discuss and determine based upon your prolapse diagnosis and other relevant factors.
Understanding your prolapse diagnosis helps you make better informed decision about your future prolapse management.
The evidence suggests that for women with mild to moderate (Stage 1- 2) prolapse diagnosis, pelvic floor muscle training may be an effective method of reversing prolapse and reducing prolapse symptoms. If you can alleviate your prolapse symptoms, you may even feel less likely to need prolapse surgery!
Michelle Kenway is an Australian Pelvic Floor Physiotherapist. Michelle lectures to health professionals and promotes community health through her writing, radio segments, online exercise videos and community presentations. She holds dual post graduate physiotherapy qualifications in women’s health and exercise.
1. Barber MD, Walters MD and Bump R (2003) Association of the magnitude of pelvic organ prolapse and presence of severity of symptoms (abstract #3 103). In International Continence Society, Florence.
2. Brækken, I. H., Majida, M., Engh, M. E., & Bø, K. (2010). Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American journal of obstetrics and gynecology, 203(2), 170-e1.
3. Bump R Mattiason A Bo K, Brubaker L DeLancey J Klarskov P Shull B Smith A (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American Journal of Obstetrics & Gynecology, 175:13.
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