What are the symptoms of Prolapse?
Many women with less severe (or low grade/ stage) prolapse have no symptoms at all and are unaware of their prolapse. If this is the case, no further treatment is necessary. The less severe forms of prolapse may only be evident on a vaginal examination by a doctor and can occur without any symptoms.
Women with more severe forms of prolapse may experience some of the following symptoms:
- A sensation of a vaginal lump or bulge which may be associated with a feeling of discomfort or pressure
- A visible lump protruding from the vagina, especially at the end of the day or with more strenuous activity
- If the prolapse is continually protruding from the vagina, vaginal discharge and bleeding can occur
- Difficulties in passing urine with poor urine flow and a feeling that the bladder does not empty completely (in the case of a large cystocele)
- Urinary incontinence
- Difficulties in emptying the bowel (in the case of a large rectocele or enterocele)
- The need to press on the prolapse with a finger in the vagina to help the passage of urine or bowel actions
- Problems with sexual intercourse
The most common symptom caused by prolapse is the sensation of a vaginal bulge or heaviness.
Prolapse symptoms often vary with a woman’s level of activity and are usually worse at the end of the day, after prolonged standing or walking and after more strenuous physical activity or lifting. Prolapse related symptoms may also vary at different times in a woman’s menstrual cycle in premenopausal women.
What is the relationship between Prolapse and Urinary Incontinence?
Women with prolapse can experience:
- Stress urinary incontinence
- Urge urinary incontinence due to an overactive bladder (OAB) as well as
- Overflow incontinence due to incomplete bladder emptying caused by the prolapse.
Prolapse and urinary incontinence do not always go hand in hand but do commonly occur together as both are caused by factors that weaken the supports of the pelvic floor such as pregnancy, childbirth and ageing. They are, however, separate problems of the pelvic floor that need to be addressed separately.
About 1 in 3 women who have prolapse surgery will also need surgery for urinary incontinence.
It may sound strange but more severe degrees of prolapse can actually hide problems with stress incontinence. This is due to the fact that a large prolapse can kink the urethra (the tube draining urine from the bladder) and hide the problem of urinary incontinence. When the prolapse is repaired or pushed back into position by a vaginal pessary, urinary incontinence can sometimes by “unmasked”. It is important to look for this hidden form of urinary incontinence particularly with a larger prolapse as it helps determine if surgical treatment for urinary incontinence will also be needed. A trial with a vaginal pessary for prolapse is another useful way to check for hidden incontinence.