Hard Prolapse
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Hard Prolapse
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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Cohee MW, et al. Benign anorectal conditions: Evaluation and management. American Family Physician. 2020;101:24.
Rectal prolapse. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract/rectal-prolapse. Accessed March 26, 2021.
Rectal prolapse. American Society of Colon & Rectal Surgeons. https://fascrs.org/patients/diseases-and-conditions/a-z/rectal-prolapse-expanded-version. Accessed March 22, 2021.
Tsunoda A. Surgical treatment of rectal prolapse in the laparoscopic era; A review of the literature. Journal of the Anus, Rectum and Colon. 2020; doi:10.23922/jarc.2019-035.
Varma MG, et al. Surgical approach to rectal procidentia (rectal prolapse). https://www.uptodate.com/contents/search. Accessed March 26, 2021.
Varma MG, et al. Overview of rectal procidentia (rectal prolapse). https://www.uptodate.com/contents/search. Accessed March 26, 2021.
Morrow ES. Allscripts EPSi. Mayo Clinic. April 16, 2021.
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Rectal prolapse occurs when the rectum becomes stretched out and protrudes from the anus.
Rectal prolapse occurs when part of the large intestine's lowest section (rectum) slips outside the muscular opening at the end of the digestive tract (anus). While rectal prolapse may cause discomfort, it's rarely a medical emergency.
Rectal prolapse can sometimes be treated with stool softeners, suppositories and other medications. But surgery is usually needed to treat rectal prolapse.
If you have rectal prolapse, you may notice a reddish mass that comes out of the anus, often while straining during a bowel movement. The mass may slip back inside the anus, or it may remain visible.
The cause for rectal prolapse is unclear. Though it's a common assumption that rectal prolapse is associated with childbirth, about one-third of women with the condition have never had children.
Certain factors may increase your risk of developing rectal prolapse, including:
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