Help! I Have A Lump Down There

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Small pelvic organ prolapse (POP) can be managed successfully by doing pelvic floor exercises under the supervision of trained physiotherapists

First of all, don’t panic, ladies. The first thing that probably crosses your mind is whether you have vaginal cancer. This is unlikely. It is more likely you have a benign condition called pelvic organ prolapse (POP).

What Is Pelvic Organ Prolapse?

POP is a vaginal lump resulting from the womb, bladder or rectum bulging into the vagina and sometimes out of the vaginal opening. This occurs due to weakness of the pelvic floor, which can be caused by vaginal deliveries, ageing and menopause.

Other aggravating factors include obesity, constipation, heavy lifting, having a persistent cough or a large pelvic mass. These risk factors are thought to increase intra-abdominal pressure, which subsequently exerts a downward force on the predisposed weakened pelvic floor.

POP is common. It affects up to 50% of women who have had vaginal deliveries especially those who have had assisted deliveries using forceps and ventouse. However, only 10% of these women will have bothersome symptoms.

Typical Complaints

Patients commonly say, “I have a dragging sensation in my vagina especially when I stand for a long time” or “I feel a vaginal lump when I shower or wipe after passing urine”. With a large POP hanging out of the vaginal opening, some may find it difficult to sit or walk.

Bleeding may occur due to ulceration caused by the POP rubbing on underwear. Some may feel that they do not empty their bladder well, thus having to pass urine frequently. Incomplete bladder emptying could also predispose one to recurrent urinary tract infections.

Others may have bowel symptoms such as constipation or feel incomplete rectal emptying. Lastly, some women may avoid sex because of the vaginal discomfort or lump, or just from pure embarrassment!

Don’t Panic

Having POP does not mean you have to have surgery. Small POPs can be managed successfully by doing pelvic floor exercises under the supervision of trained physiotherapists and by addressing the reversible risk factors such as losing weight, avoiding constipation and heavy lifting, and treating chronic coughs.

There are also medical devices in the form of vaginal pessaries, which can be inserted into the vagina to lift and support the POP. Surgery is generally indicated when conservative measures fail to alleviate POP symptoms or when the patient chooses to have surgery.

It is best for you to consult your doctor if you suspect you have POP or any of its related symptoms. You do not have to just “grin and bear it” as there are non-surgical and surgical treatment options which aim to improve your quality of life.