The uterus is the medical name for the womb. It includes the neck of the womb (cervix) from where the smear test is taken. After the menopause (the change) periods stop and the womb is no longer needed for babies. As hormone levels fall at this time, the womb usually gets a bit smaller. The womb normally sits in the pelvis which is the place between the hip bones at the bottom of the abdomen (tummy). The pelvic bones form a strong circle and have a sheet of muscles forming a hammock between them – these muscles are the pelvic floor muscles. The pelvic floor muscles support the womb, the top of the vagina (front passage), the bladder and the rectum (back passage). If this muscle sheet is weak, the organs it supports can sag down with gravity. Having babies and getting older may weaken the pelvic floor muscles. This sagging forms bulges into the vagina because the walls of the vagina are stretchy. This sagging is called Prolapse. When the womb is sagging it is called Uterine Prolapse. Sometimes the womb sags so much that the neck of the womb pokes out of the vaginal opening. Uterine prolapse can cause you to have a lump in the vagina that you can see or feel. The lump is often smaller first thing in the morning but gets bigger during the day when you are on your feet. The lump can be uncomfortable, it may get in the way of having sex or putting in tampons. If the lump pokes out, it can rub on your underwear and get sore and sometimes gets in the way of the bladder emptying properly.

Do nothing– if the prolapse (bulge) is not distressing then treatment is not necessarily needed. If, however, the prolapse permanently protrudes through the opening to the vagina and is exposed to the air, it may become dried out and eventually ulcerate. Even if it is not causing symptoms in this situation it is probably best to push it back with a ring pessary (see below) or have an operation to repair it. Pelvic floor exercises (PFE) -The pelvic floor muscle runs from the coccyx at the back to the pubic bone at the front and off to the sides. This muscle supports your pelvic organs (uterus, vagina, bladder and rectum). Any muscle in the body needs exercise to keep it strong so that it functions properly. This is more important if that muscle has been damaged. PFE can strengthen the pelvic floor and therefore give more support to the pelvic organs. These exercises may not get rid of the prolapse but they make you more comfortable. An expert who is usually a Physiotherapist best teaches PFE. These exercises have no risk and even if surgery is required at a later date, they will help your overall chance of being more comfortable. Types of Pessary This usually gets rid of the dragging sensation and can improve urinary and bowel symptoms. It needs to be changed every 6-9 months and can be very popular; we can show you an example in clinic. Other pessaries may be used if the Ring pessary is not suitable. Some couples feel that the pessary gets in the way during sexual intercourse, but many couples are not bothered by it. Shelf Pessary or Gellhorn- If you are not sexually active this is a stronger pessary which can be inserted into the vagina and needs changing every 4-6 months.