If you have noticed a bulge in your vagina, a dragging feeling in your lower belly, or if you leak urine when you cough or exercise, you are not alone. Pelvic prolapse and urinary incontinence are extremely common, and extremely treatable. This guide explains what is happening, what to expect at an appointment, and the full range of options from physiotherapy to surgery.
What is pelvic organ prolapse?
The pelvic organs (bladder, uterus, and rectum) are held in place by a group of muscles and ligaments called the pelvic floor. When these supports weaken, the organs can drop down into the vagina. This is called pelvic organ prolapse.
There are three main types, often happening together:
1. Cystocele: the bladder drops into the front wall of the vagina.
2. Rectocele: the rectum pushes into the back wall of the vagina.
3. Uterine prolapse: the uterus itself drops down into the vaginal canal.
If the uterus has already been removed, a vaginal vault prolapse can happen instead.
What causes prolapse and incontinence?
The main risk factors are things that stretch or weaken the pelvic floor over time:
1. Vaginal childbirth, especially multiple births or large babies.
2. Menopause and the drop in oestrogen that follows.
3. Chronic coughing (asthma, smoking, hay fever).
4. Repeated heavy lifting at work or in the gym.
5. Chronic constipation and straining.
6. Being significantly overweight.
7. Family history and genetics (some women have naturally weaker connective tissue).
Symptoms of prolapse
Prolapse symptoms can be very mild or quite distressing. Common signs include a visible or felt bulge in the vagina, a heavy or dragging sensation in the lower belly, discomfort during sex, difficulty inserting tampons, and a feeling that the bladder or bowel does not empty properly. Our top 8 symptoms of a pelvic prolapse blog goes into more detail.
Symptoms of urinary incontinence
Stress incontinence
Leaking a small amount of urine when you cough, laugh, sneeze, lift, or exercise. This is usually due to weakness in the support of the urethra.
Urge incontinence (overactive bladder)
A sudden strong urge to pass urine with little warning, often with leaking before you reach the toilet. The bladder muscle is squeezing when it should not.
Mixed incontinence
Many women have a mix of stress and urge symptoms. Our existing blog on urinary incontinence types and treatments explains each one.
How is prolapse and incontinence diagnosed?
Diagnosis starts with a careful conversation about your symptoms, your pregnancy history, your menopause status, and your bladder and bowel patterns. A gentle pelvic examination lets your specialist assess the type and degree of prolapse.
Depending on your symptoms, extra tests may include a bladder diary, a urine test, pelvic ultrasound, or specialised bladder tests called urodynamics.
Non-surgical treatment options
Lifestyle changes
Weight loss, treating constipation, avoiding heavy lifting, and managing chronic cough all reduce pressure on the pelvic floor. Our blog on how to reduce your risk of prolapse covers these steps in practical detail.
Pelvic floor physiotherapy
A specialised pelvic floor physiotherapist can teach you the right way to activate and strengthen the muscles. This is often the first and most effective step for mild to moderate symptoms, especially stress incontinence and early prolapse.
Vaginal pessaries
A pessary is a soft silicone device placed in the vagina that supports the prolapsed organs. It can be a very good solution for women who want to avoid or delay surgery, or who are not fit for surgery. Pessaries come in many shapes and sizes. Your specialist will fit the right one and teach you how to care for it.
Vaginal oestrogen
Low-dose vaginal oestrogen cream or pessary strengthens the vaginal walls and bladder tissue after menopause. It is a safe local treatment and works well alongside physiotherapy.
Bladder training and medications
For urge incontinence, bladder training (gradually extending the time between visits to the toilet) combined with medications can help calm an overactive bladder.
PRP as a supportive option
Vaginal PRP using growth factors from your own blood can support tissue health in mild stress incontinence. It is not a replacement for pelvic floor work or surgery, but it can be part of a wider treatment plan.
Surgical treatment options
Surgery is usually recommended when non-surgical options have not given enough improvement, or when the prolapse is severe.
Native tissue prolapse repair
The weakened areas of the vaginal wall are repaired using your own tissue. This is done through the vagina, with no cuts on the tummy. Most women stay in hospital 1-2 nights and return to light activity fairly shortly.
Hysterectomy with prolapse repair
If the uterus is prolapsed and other options have been considered, removing the uterus (hysterectomy) is often combined with repair of the vaginal walls.
Sub-urethral sling for stress incontinence
A short strip of mesh is placed under the urethra to support it during coughing or activity. It is a day procedure for most women, with high success rates for stress incontinence that has not responded to physiotherapy.
When should you see a specialist?
See a specialist gynaecologist when:
1. Your symptoms are affecting your daily life, exercise, or intimacy.
2. You have tried pelvic floor physiotherapy and want to explore the next step.
3. You are interested in a pessary.
4. You feel a bulge that you can see or that comes down when you strain.
5. You are leaking enough to need pads.
Many women feel embarrassed to raise these issues. Our blog on what nobody tells you about urinary incontinence explains why that silence is one of the biggest obstacles to good care.
About Northside Gynaecology and pelvic health
Northside Gynaecology is a specialist gynaecology practice in Brisbane. Our team, led by Dr Archna Saraswat, FRANZCOG, offers full assessment and the complete range of modern pelvic health options, from physiotherapy support through to advanced surgical repair. We consult from Kedron, North Lakes, and Caboolture Private Hospital.
Frequently asked questions
What is pelvic organ prolapse?
Pelvic organ prolapse is when the bladder, uterus, or rectum drops down into the vagina because the support tissues have weakened. It is very common, affecting up to half of women who have had children. Symptoms can include a dragging sensation, a visible bulge, or trouble emptying the bladder or bowel.
What is the difference between stress and urge incontinence?
Stress incontinence is leaking when you cough, sneeze, laugh, or exercise. It is due to weakness in the support of the bladder neck. Urge incontinence is a sudden strong need to pass urine with little warning, and sometimes leaking before you reach the toilet. Many women have a mix of both.
Can prolapse be fixed without surgery?
Yes, in many cases. Pelvic floor physiotherapy and vaginal pessaries can manage mild to moderate prolapse very effectively. Surgery is usually offered when non-surgical options are not enough or when the prolapse is severe.
Do I need to see a specialist or can my GP help?
Many GPs can start the first steps, like a referral to pelvic floor physiotherapy. A specialist gynaecologist assessment is useful if symptoms are affecting your life, if a pessary is being considered, or if surgery may be needed.
Is prolapse surgery permanent?
Modern prolapse surgery gives good long-term results for most women. However, prolapse can return in some cases, especially if lifestyle factors like heavy lifting or chronic cough are not managed. Your specialist will discuss realistic expectations before surgery.
How long is recovery after prolapse surgery?
Most women are home within 1-2 days. Light activity resumes within 1 to 2 weeks. Full activity, including gym and heavy lifting, is usually possible by 6 to 8 weeks. Your specialist will give you a personal plan.
Can I have sex after prolapse surgery?
Yes. Most women return to sex comfortably by about 6 weeks after surgery. If sex is uncomfortable before surgery, it can improve afterwards.
Book a prolapse or incontinence consultation in Brisbane
You do not have to live with symptoms that are affecting your life or stopping you from doing what you love. Help is available, and the first step is a specialist consultation.
You can book at Kedron, North Lakes, or Caboolture. Call 07 3054 4687 or use our contact page. Ask your GP for a referral so you can claim your Medicare rebate. Bring any pelvic floor physiotherapy notes or bladder diary you have.