Reviewed on : 3 Oct 2019

Reviewed by : Mr Tony Parsons - Consultant Gynaecologist. Helen Dyer RSS. Gateway Editor

Expires : 3 Oct 2021

Female genital prolapse

Surgical treatment is not funded for asymptomatic or mildly symptomatic pelvic organ prolapse.

Prior approval from the Clinical Commissioning Group (CCG) will be required before any treatment proceeds in secondary care.

Definition of Prolapse:

Grade 2 moderate

Grade 3 & 4 severe

• Grade 0 – Normal position
• Grade 1 – Descent into vagina not reaching introitus
• Grade 2 – Descent just outside the introitus MODERATE
• Grade 3 – Descent outside the introitus – beyond 2 cms SEVERE
• Grade 4 – Procidentia SEVERE

Mild / moderate symptoms

Offer appropriate conservative management:

• Weight loss if BMI >30
• Constipation treatment to minimise straining
• Management of any cough
• Pelvic floor muscle training click for leaflet
• Gynaecological Physiotherapy (specialist physiotherapist Charlotte Leung Women’s Health Clinic on the NHS eReferral Service) or refer Community Gynae Clinic click link
• Urinary incontinence with prolapse – Ring or other pessary (fit in Primary Care or refer to Community Gynae Clinic click link)

Severe symptoms

Referral for secondary care assessment is indicated for any of the following:

• Failure of primary care or community management in moderate or severe prolapse with a history of ring or other pessary failure
• Prolapse combined with faecal incontinence or urinary incontinence that has failed to respond to conservative management or combined with urethral sphincter incompetence
• Isolated rectal prolapse as the use of pessary is ineffective

Urinary Symptoms without Prolapse

Should be referred to Urology or Continence Clinic click link