Does every prolapse need treatment?

No. Mild prolapse that is not really bothering you can often be monitored. But if prolapse is affecting comfort, activity, bladder or bowel function, sex, or confidence, effective treatment is available and many women benefit from active treatment, including surgery when appropriate.

Will prolapse always keep getting worse?

Not always. Some prolapse stays fairly stable for long periods, and how much it matters depends on both the examination findings and how much it is affecting daily life. You do not need to wait until symptoms are severe before seeking treatment.

Can prolapse cause bladder or bowel symptoms?

Yes. Prolapse can overlap with bladder urgency, frequency, incomplete emptying, slow flow, bowel emptying difficulty, pressure, and the need to strain or splint. That is why the whole symptom pattern matters, not only the bulge.

Can pelvic floor exercises help prolapse?

Pelvic floor physiotherapy can often reduce symptoms, improve support strategies, and help confidence and control, especially in earlier prolapse. It may not make a bulge disappear completely, but it is often still a very worthwhile first step and can still support care before or after surgery.

A pessary is a fitted vaginal support device. In the right patient it can reduce bulge symptoms quickly and can be a useful option if you want a non-surgical step, want to delay surgery, or are not ready for an operation.

Why do you use perineal ultrasound in prolapse assessment?

It helps correlate the symptom story with the examination and the support defect more clearly. In my practice, that often makes it easier to decide whether the better route is supportive treatment, a pessary, or a reconstructive discussion.

How do you decide on surgery?

That depends on what symptoms are actually bothering you, which compartment is leading, whether the uterus or vaginal vault is involved, whether you have bladder or bowel overlap, what you have already tried, and whether you want a more definitive repair. Surgery does not have to be a last resort if it is clearly the best fit for your symptoms and goals.

Does prolapse surgery always mean hysterectomy or mesh?

No. Some prolapse operations are native-tissue vaginal repairs, some involve apical suspension, some include hysterectomy, and some selected apical operations use mesh placed abdominally. The right choice depends on the anatomy, the support defect, and your goals.

Is prolapse dangerous?

Usually prolapse is not dangerous, but earlier review matters if the bulge becomes suddenly painful, swollen, bleeding, ulcerated, or if you cannot empty your bladder properly.

SPECIALIST UROGYNAECOLOGY

Prolapse &
pelvic floor

A vaginal bulge, heaviness or a feeling that something is coming down can affect comfort and confidence. Together, we work out what is causing your symptoms and which treatment fits your life.

Request an appointment WhatsApp reception Explore your options ↓

FIND YOUR STARTING POINT

Explore your symptoms and options.

UNDERSTANDING PELVIC SUPPORT

What is happening when you feel a bulge?

Muscles, ligaments and connective tissue support the pelvic organs. When this support changes, the vaginal walls, uterus or top of the vagina can descend. More than one area may be involved.

Childbirth, inherited tissue strength, ageing and pressure from constipation or a persistent cough can contribute. Prolapse is not simply a result of doing too few exercises. Its stage on examination does not always reflect how much it bothers you.

The different support areas

The bladder sits in front of the vagina, the rectum behind it and the uterus above it. Prolapse can affect more than one support area. These are different types, not stages of worsening disease.

FRONT WALL · ANTERIOR

Bladder-side support

Side-view illustration of a cystocoele: the bladder bulges down with the front vaginal wall into the vaginal space.

The bladder and front vaginal wall can bulge into the vaginal space and towards the opening. This is called anterior vaginal-wall prolapse, or a cystocele.

BACK WALL · POSTERIOR

Bowel-side support

Side-view illustration of a rectocoele: a hollow pouch of the rectum pushes the back vaginal wall forwards; the anal canal remains separate.

The rectum can push the back vaginal wall into the vaginal space, forming a rectocele. This may affect bowel emptying and differs from rectal prolapse through the anus.

TOP SUPPORT · APICAL

Uterus or vaginal apex

Side-view illustration of uterine prolapse: the uterus and cervix descend with the upper vaginal walls towards the opening.

The uterus and cervix can descend towards the vaginal opening, as illustrated. After hysterectomy, the top of the vagina can also descend; this is called vault prolapse.

YOUR CONSULTATION

Understand the support. Plan your care.

Your symptoms and priorities
We discuss the bulge, bladder and bowel function, intimacy, activity, previous treatment and future pregnancy plans. Your goals help guide the choices.
Examination and relevant tests
With your consent, I assess the support, vaginal tissues and pelvic muscles, sometimes standing or straining. You can pause or stop the examination. Bladder-emptying checks or other tests depend on your symptoms.
A plan and follow-up
We discuss what each option may help, its limitations and your preferences. We agree on the next step and when to review progress or reconsider the plan.

Where perineal ultrasound helps

I use perineal ultrasound alongside the examination to look at pelvic support and movement, explaining what the findings add to your plan. A scan is not needed simply to confirm every prolapse already seen on examination.

About perineal ultrasound

YOUR TREATMENT CHOICES

Choosing treatment for prolapse.

Your symptoms, support pattern and preferences guide treatment. Options can be combined; they are not compulsory steps towards surgery.

Monitoring & supportive care

If symptoms are mild and function is unaffected, monitoring may be enough. Managing constipation or a persistent cough can help. Vaginal oestrogen may ease accompanying menopausal dryness or irritation; it does not lift the prolapse.

Menopause and pelvic comfort

Pelvic floor physiotherapy

A supervised programme can improve muscle function and symptoms over several months. Treatment may include strength, coordination, relaxation and activity advice. It may not remove the bulge completely.

Physiotherapy for prolapse

Pessary support

A fitted vaginal device supports the prolapse while in place. It can be an ongoing choice or help while you consider surgery. Finding a comfortable fit may take more than one attempt; cleaning and follow-up are part of care.

Pessary fitting and care

Surgery & repair planning

Surgery can be considered when symptoms remain troublesome or you prefer it after discussing alternatives. A repair may address several support areas together. We discuss likely benefit, recurrence and effects on bladder, bowel and sexual function.

Explore prolapse surgery

Keeping the uterus, mesh and the surgical approach

Hysterectomy is not automatically necessary. Some repairs use your own tissues and stitches; others use mesh. Abdominally placed prolapse mesh differs from transvaginal prolapse mesh and a continence sling, with different uses and risks.

I offer vaginal, laparoscopic and robotic-assisted prolapse repair, with the approach chosen for your support problem, health and previous surgery. Robotic surgery is one option, not a requirement for a good repair.

The decisions before surgery Robotic surgery at Life Kingsbury

THE WIDER PICTURE

When symptoms overlap or return.

Repairing support may not resolve urgency, constipation or pelvic pain. Leakage may become apparent after a pessary or repair supports the prolapse. We assess these concerns together and plan any additional care.

After a previous repair, I review what was treated and what is bothering you now. Operation notes can help, but you can book without them. A further operation is not automatically the next step.

Bladder symptoms Bowel symptoms Pain and sexual discomfort Symptoms after previous pelvic surgery Pelvic floor symptoms after childbirth Rectocele and bowel emptying

COMMON QUESTIONS

Living with prolapse.

Does prolapse always get worse or need surgery?

No. Symptoms may remain stable, and monitoring, physiotherapy or a pessary may suit you. The effect on your life matters alongside examination findings. You do not need to wait until symptoms are severe to seek help.

Can I stay active and have sex?

Prolapse does not automatically mean stopping exercise or sex. Advice depends on your comfort, symptoms and any recent operation. Physiotherapy or pessary support may help activity; some pessaries can stay in during intercourse, while others need removal. Pain or bleeding deserves assessment.

What if I want another pregnancy?

Tell me before choosing treatment. Pregnancy and birth can affect pelvic support, so definitive repair is often deferred until your family is complete. Physiotherapy or a pessary may help meanwhile; the plan is individual.

What should I expect after surgery?

Recovery depends on the repair and your health. We discuss help at home, activity, work, intimacy and follow-up before surgery, with individual instructions through the consent process.

Recovery after prolapse surgery

YOUR NEXT STEP

Discuss your symptoms and options.

Consultations in Claremont, with additional appointments in Simon’s Town on selected Mondays. Reception will confirm your date, time and venue.

Request an appointment Call 021 518 3416 Fees & medical aid Locations & directions

General information to support your consultation. Your assessment and treatment plan are individual.

Page updated: 27 September 2026.

Sources & further reading: NICE: prolapse assessment and treatment · NICE: pelvic floor care · IUGA: pelvic organ prolapse · RCOG: understanding prolapse · NHS: pelvic pain and urgent help · NIDDK: urinary retention