Pelvic Organ Prolapse Treatment in Singapore

What is pelvic organ prolapse?

Pelvic organ prolapse refers to a drooping of the uterus, bladder or rectum into and beyond the vaginal canal. It is more common in older women, affecting 1 in 3 women who have had children. 1 in 10 women will need surgery in their lifetime for pelvic organ prolapse.

Pelvic organ prolapse can occur in any of the 3 different compartments of the vagina as follows:

Anterior Prolapse (front wall of the vagina)/ “cystocele”

Anterior prolapse is the most common; it is is medically called a cystocele, and involves the bladder bulging into the vaginal canal through the front wall.

Posterior Prolapse (back wall of the vagina)/ “rectocele”/ “enterocele”

This is medically called a rectocele if it involves the rectum bulging into the vaginal canal through the lower back wall, and an enterocele if it involves the small intestine bulging into the vaginal canal through the upper back wall.

Apical Prolapse (uterus/ top of vagina)

This is second most common, where the uterus drops into the vaginal canal (uterine prolapse). For women with previous hysterectomy (removal of the uterus), the top of the vagina may collapse downwards out of the vaginal opening.

Most women will have a combination of 1 or more prolapse. Because of the common cause of weakened pelvic floor muscles, many women may suffer from both pelvic organ prolapse and urinary incontinence. 

Why does pelvic organ prolapse happen?

The main cause of this is weakened pelvic floor muscles from damage sustained during pregnancy and childbirth as well as weakening from ageing and menopause. Another major cause of pelvic organ prolapse involves chronic increased pressure on pelvic floor muscles e.g. obesity, chronic cough, chronic constipation, jobs that involve heavy lifting/straining.

Lady holding on to female uterus dummy

What are the symptoms of pelvic organ prolapse?

Some women have no symptoms at all and are only picked up during a routine gynaecology check. Others may have symptoms that include:

  • Feeling of a lump in the vagina
  • Heavy, dragging sensation in the vagina, which may extend to the lower back
  • Bleeding after menopause
  • Urinary frequency and urgency
  • Urinary incontinence
  • Difficulty passing urine e.g. slow stream or feeling of incomplete bladder emptying
  • Constipation
  • Painful sex

Is pelvic organ prolapse painful?

Pelvic organ prolapse does not cause pain in majority of cases, but can be associated with discomfort if the prolapse is severe, particularly in terms of a heavy dragging sensation or discomfort during sexual intercourse. 

Remember – pelvic organ prolapse (mostly) does not affect your physical health, but can significantly affect your quality of life.

Who is at risk of pelvic organ prolapse in Singapore? 

Midlife women (of peri-menopausal and menopausal age) with previous childbearing are of particular risk of having pelvic organ prolapse in Singapore. In addition, women who are obese with a high body mass index (BMI), or are prone to straining or carrying heavy loads are also at higher risk of having pelvic organ prolapse.

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Our Consultant OB-GYN Urogynaecologist

Doctor holding on to female uterus dummy

What are the treatments for pelvic organ prolapse in Singapore?

If you suspect you may be having pelvic organ prolapse, you should consult a urogynaecologist, who is a gynaecologist specialising in female urinary disorders. Your urogynaecologist will be able to determine what type of pelvic organ prolapse you have, its severity and your treatment options. Your doctor will take a detailed medical history and perform a pelvic examination to check for the stage of your pelvic organ prolapse and pelvic floor muscle tone. An ultrasound scan will need to be performed to check your uterus and ovaries, and a bladder scan done to check the amount of urine remaining in your bladder after you have passed urine). Depending on your symptoms, you may also require urine tests and Pap smear/HPV test.

Some women may choose to do nothing and just observe if they are not having any symptoms. Treatment options include non-surgical and surgical.

Non-surgical treatment options for pelvic organ prolapse in Singapore

Kegel exercises

These strengthen the weakened pelvic floor muscle tone and can improve mild pelvic organ prolapse. Kegel exercises need consistent daily efforts for at least 3 to 6 months to see results.

Here are some tips on how to do Kegel exercises:

  • Try and imagine that you are trying to stop a fart from coming out, or trying to stop your urine flow in the middle of the stream. You may find it useful to find the correct muscles by actually doing this while you are sitting on the toilet bowl, but do not do it routinely as you may teach your bladder bad habits!
  • Lie down on your bed with your knees bent and legs slightly apart
  • Put a small mirror in between your legs and observe your vagina and anus openings while you try and squeeze your pelvic floor muscles. You should see the openings getting smaller and being lifted in and upwards

It is normal for you to take some time to learn which are the correct muscles and how to squeeze and relax sufficiently at first. Don’t worry and be patient!

Once you have identified the correct muscles:

  1. Squeeze your pelvic floor muscles and hold for 1 second – repeat 5 times
  2. Squeeze and hold for 5 seconds – repeat 5 times
  3. Step 1 + Step 2 = 1 cycle (30 seconds)
  4. Do 5 cycles (2-3 minutes) three or four times a day (7-10 minutes)

The key is remembering to do your Kegel exercises daily. You can do them any time, in any place and in any position as nobody can tell that you are doing them! Don’t limit yourself to the sets above – if you can do it more often, do so.

If you have difficulty grasping the technique of Kegel’s exercises, speak with your urogynaecologist who can refer you to a specialised physiotherapist.

As it is likely that your pelvic floor muscles have weakened, you may not see results until you have put in consistent efforts for at least 3 to 6 months. Remember – slow and steady wins the race!

Lifestyle changes

Avoid increased pressure on pelvic floor muscles by losing weight to maintain a healthy body mass index (BMI), treating conditions such as chronic cough and constipation, not lifting heavy loads.

Vaginal pessaries

These are soft, removable devices that is inserted in your vagina to support your prolapsed pelvic organs and hence provide relief of your symptoms of POP. This is temporary as if the pessary is removed, POP will recur. Vaginal pessaries come in many different shapes and sizes. The most commonly used one is the ring pessary, which needs to be removed, washed and replaced by your gynaecologist every 3-4 months or so.

Surgical treatment options for pelvic organ prolapse in Singapore 

The type of surgery advised by your urogynaecologist will depend on your severity of pelvic organ prolapse, age, general health, medical conditions, surgical history and sexual activity.  There is no one-size-fits-all. Each surgery for POP needs to be individualised. 

Vaginal pelvic reconstructive surgery

This is the most common approach as the pelvic organs are drooping out from the vagina. If the uterus is prolapsed, there is no plans for more children and the woman has no desire to keep her uterus, a vaginal hysterectomy will be performed. The ovaries can be conserved if they are normal.

Surgery for prolapse in the other compartments (pelvic floor repair) involves making a cut in the vagina and separating the prolapsed organ away from the vaginal wall. Stitches or mesh are used to strengthen the defect in the supporting tissue, and the vaginal skin is closed to reduce the bulge.

If this is done for the bladder (anterior prolapse or cystocele), it is known as an anterior repair or colporraphy. If this is done for the rectum, it is known as a posterior repair or colporraphy. In some cases, additional permanent sutures may be placed to hitch the top of the vagina to a strong ligament in the pelvis to provide additional support (sacrospinous ligament fixation/SSLF). Overall, there are no cuts on the abdomen.

Risks of surgery include:

Common (affecting 1-5% of patients):

  • Vaginal bleeding / haematoma – in cases of significant bleeding, blood transfusion and/or additional procedures may be required to stop the bleeding
  • Postoperative pain (in cases of SSLF, this is usually involves the right buttock and usually resolves in a few weeks)
  • Urinary retention, infection, frequency, urgency, urge and urinary incontinence
  • Wound infection
  • Constipation
  • Difficulty and/or pain with intercourse
  • Failure to achieve the desired result; recurrence of prolapse
  • Earlier onset of menopause

Uncommon (affecting 0.1-1% of patients):

  • Injury to the bladder
  • Pelvic abscess
  • Venous thrombosis (Blood clot in legs) / Pulmonary embolism (Blood clot in lungs)

Rare (affecting <0.1% of patients):

  • Serious adverse reactions to general anaesthesia
  • Excessive bleeding requiring transfusion or return to theatre
  • Injury to the urinary tract / bowel
  • Admission to the intensive care unit for monitoring should the operation be of prolonged duration or result in complications
  • Death: the risk is approximately less than 1 in 4000
Abdominal approach (sacrocolpopexy)

This is an option for women with previous hysterectomy and an apical prolapse (top of vagina collapsing downwards out of the vaginal opening). It involves making cuts in the abdomen and using a permanent synthetic mesh to hitch the vagina up to the sacrum, which is a large triangular bone at the base of the spine.

Vaginal closure surgery

In a few instances, vaginal closure surgery may be recommended for women with severe prolapse who are medically unfit for vaginal pelvic reconstructive surgery and are not sexually active. This surgery involves pushing the prolapsed organs back into the vagina and stitching the vaginal walls together.

How successful is surgical treatment for pelvic organ prolapse?

70% of women will have a long-term cure after undergoing surgery for POP. For those with permanent implantation of synthetic mesh, the success rate goes up to 90%. It is important to note that the limitation of pelvic reconstructive surgery lies in working with ageing/ weakened tissues. Hence, pelvic organ prolapse typically recurs due to persistent risk factors that caused the initial prolapse. Although ageing cannot be reversed, lifestyle modifications like maintaining a healthy body mass index (BMI), avoiding chronic cough, constipation and lifting heavy loads remain essential.

Urogynae package

At ACRM, we believe that women should no longer suffer in silence from common urogynaecological conditions such as sagging pelvic organs, urinary incontinence and bladder issues. Be it after childbirth or as you mature and age, the ACRM Urogyn package works with you to provide personalised solutions for urogynaecological issues ensuring early detection and treatment of these conditions.

  • $ $350 Package excludes GST
  • Consultation with Specialist Female Urogynaecologist

    • Detailed history for symptoms of pelvic organ prolapse, urinary incontinence or other bladder issues, including any significant medical conditions or previous surgeries.
    • Physical examination to assess for presence and/or severity of pelvic organ prolapse, as well as pelvic floor muscle strength and tone.

    Pelvic (transvaginal) ultrasound

    Exclude uterus and/or ovary abnormalities e.g. fibroids, polyps, cysts 

    Bladder (transabdominal) scan

    Check for residual urine (bladder emptying function)

    Urine analysis

    Check for urinary tract infections, blood in urine

    Bedside one-on-one education

    Hands-on teaching on Kegel (pelvic floor) exercises and techniques

    Tailored treatment plan

    Customised treatment proposal for any urogynaecological issues identified

Talk to us today!

Our Consultant OB-GYN Urogynaecologist