Obstetric & Gynaecology Malaysia


Pelvic organ prolapse is a condition that affects the "pelvic floor." The pelvic floor is the name for the muscles that support the organs in the pelvis. These organs include the bladder, rectum, and uterus . Pelvic organ prolapse is when these muscles are overstretched. This causes the organs to drop down and press against or bulge into the vagina.

Prolapse can affect different organs 

  • Uterine prolapse if the uterus bulges into the vagina
  • Cystocele if  the bladder bulges into the vagina
  • Rectocele if the rectum bulges into the vagina
  • Vault prolapse if the vaginal wall drop down after a woman has hysterectomy, removal of her uterus.

Risk of a woman having pelvic organ prolapse is increased by genetic factors, obesity, older age, increased in abdominal pressure from coughing, sneezing, carrying excessive heavy loads, straining during constipation, pregnancy and childbirth

What are the symptoms of pelvic organ prolapse?

Many times, prolapse does not cause any symptoms. But when symptoms do happen, they can include:

●Fullness or pressure in the pelvis or vagina

●An aching feeling in the pelvis or lower back

●A bulge in the vagina or coming out of the vagina

●Difficulty to pass urine after prolonged standing

●Needing to urinate all of a sudden after resting or waking up from sleep

●Trouble having a bowel movement

When using the toilet, you might need to press on the bulge in your vagina with a finger to get out all your urine or to finish a bowel movement.

Is there a test for pelvic organ prolapse?

The doctor perform a pelvic examination. and ultrasound pelvis to exclude growth in your pelvis 

How is pelvic organ prolapse treated?

People who have no symptoms or who are not bothered by their symptoms do not need treatment. If you do have symptoms that bother you, your treatment options might include:

●Pelvic floor muscle exercises – This involves working with a physical therapist for 8 to 12 weeks to strengthen your pelvic muscles.

●A vaginal pessary – This is a device that fits inside your vagina. It supports the bladder and pushes it back into place. Pessaries come in different shapes and sizes. Your doctor or nurse will talk to you about your options and make sure your pessary fits your body.

●Surgery – A surgeon can move organs back where they belong and strengthen the tissues that keep them in place. Surgery might be an option if you do not plan to have children or are done having children.

Can pelvic organ prolapse be prevented?

You can reduce your chances of pelvic organ prolapse if you:

●Lose weight if you are overweight.

●Get treated for constipation if you are constipated.

●Avoid activities that require you to lift heavy things.

Is there anything I can do on my own to feel better?

Some people feel better if they do pelvic muscle exercises. These exercises strengthen the muscles that control the flow of urine and bowel movements. They are also known as "Kegel" exercises. Your doctor can teach you how to do them, or they might refer you to a physical therapist who specializes in pelvic floor problems.

How do I learn how to do pelvic muscle exercises?

You will need to learn which muscles to tighten. It is sometimes hard to figure out the right muscles. Below are some ways you can practice:

  • Squeeze the muscles you would use to avoid passing gas.
  • Put a finger inside your vagina and squeeze the muscles around your finger.
  • Squeeze the muscles that control the flow of urine, avoid practicing these exercise while passing urine, except to learn which muscles to squeeze.

No matter how you learn to do pelvic muscle exercises, it's important to know is that the muscles involved are not in your belly, thighs, or buttocks.

After you learn which muscles to tighten, you can do the exercises in any position (standing, sitting, or lying down).

How often should I do the exercises?

A common approach is to try to do a set of the exercises 3 times a day.

For each set, do the following about 10 times:

●Squeeze your pelvic muscles.

●Hold the muscles tight for about 10 seconds.

●Relax the muscles completely.

How do pelvic muscle exercises help?

Pelvic muscle exercises can help:

●Prevent urine leaks in people who have "stress incontinence" – This means they leak urine when they cough, laugh, sneeze, or strain.

●Control sudden urges to urinate – These happen to people with "urinary urgency" or "urge incontinence."

●Control the release of gas or bowel movements

●Improve symptoms caused by pelvic organ prolapse – These can include pressure or bulging in the vagina. 

It might take a few months of doing the exercises regularly before you notice them working. If you have been doing pelvic muscle exercises for several months and they don't seem to be making a difference, tell your doctor or nurse. They might suggest seeing a physical therapist or trying other treatments for your condition.