Pelvic Organ Prolapse: A Menopause Reality?

I am writing this from a place I didn't expect to find myself. Not from behind the treatment couch, speaking with clinical authority, but from the much more vulnerable position of being a patient or rather, of being a woman whose body is doing something that has the potential to frighten and disorient her.

I was diagnosed recently with a vaginal prolapse - a rectocele (grade 2) and a cystocele (grade 1). In plain language: the wall between my rectum and vagina has weakened and bulged forward, and my bladder has dropped. This is pelvic organ prolapse and while it is extraordinarily common (estimates suggest around half of women who have had children will experience some degree of it), it remains one of the least talked-about realities of the female journey.

I am a practitioner and I understand female anatomy. I work with women's bodies most days and this has still been genuinely distressing for me personally.  I have had to dig deep, take many deep breaths and have some serious conversations with myself!

I'm sharing this because I believe that if this lands this hard on someone who has a professional framework for understanding it, then the average woman reaching menopause, with no map and no language for what's happening, must find it almost overwhelming.

What is actually happening in a prolapse of the vagina?

The pelvic floor is a hammock of muscles, ligaments, and fascia that spans the base of the pelvis. It supports the bladder, uterus, and rectum — holding everything in place and coordinating with the breath, the spine, and the deep abdominal muscles in an intricate, largely unconscious choreography.

A cystocele occurs when the bladder pushes through a weakened anterior vaginal wall. A rectocele occurs when the rectum bulges through a weakened posterior vaginal wall. Both can cause a sensation of heaviness or pressure in the pelvis, a feeling of something falling out.  It can also cause incomplete bladder or bowel emptying and discomfort during exercise or sex.

These are not rare conditions and it is important to stress that they are not shameful ones. However, these things often come to us and, sometimes without warning.   When they come, they ask something of us...

The TCM View: What Is the Body Saying?

In Chinese medicine, this is understood primarily as a condition of sinking Qi and specifically, the failure of the Middle Qi (Zhong Qi) to hold and lift the organs in place. This is governed largely by the organ known as the Spleen, which in TCM is responsible not just for digestion but for the entire function of raising and containing and/or keeping organs where they should be.  The Spleen is also responsible for holding blood in the vessels and maintaining the structural integrity of the body's interior.  Problems in this area can lead to varicose veins, haemorrhoids and bloating and prolapse of the rectum, uterus, or bladder. The body's ability to hold itself up is compromised.

But it rarely ends there. Prolapse at menopause typically involves a layered pattern:

Kidney Jing and Yin Deficiency 

The Kidneys govern reproduction, ageing, and the structural substance of the body. As we move through menopause, Kidney Jing naturally declines. The tissues, including the ligaments, fascia, and muscular structures of the pelvis, lose their nourishment and resilience. This is why prolapse becomes more common in the perimenopausal and post-menopausal years. It is not a failure; it is a physiological reality that TCM recognised thousands of years ago.

Liver Qi Stagnation — Chronic tension, unprocessed stress, and the emotional tension of midlife often show up in the Liver channel. The Liver governs the sinews - the tendons and connective tissue. When Liver Qi stagnates and the sinews are poorly nourished, the integrity of the pelvic floor is further compromised. There is also a direct Liver channel pathway through the genitals.

Dampness - In some presentations, particularly where there is heaviness, sluggishness, and a sense of congestion, Dampness accumulating in the Lower Jiao adds to the downward pressure.

Why Menopause Changes Everything

The shift through perimenopause is profound. Oestrogen, which has been quietly maintaining the elasticity of vaginal and urethral tissues, the tone of pelvic ligaments, and the health of the pelvic floor fascia, begins to decline. From a Western perspective, this accounts for much of the vulnerability. From a TCM perspective, we say that the Tian Gui - the heavenly water or the fertile essence, is withdrawing. The body is moving into a new phase.

This is not pathology. But it is also not nothing.

There is tragedy here in the fact of how often women arrive at this moment completely unprepared. They have managed periods, pregnancies, and decades of holding everything together (literally and figuratively), and now they are confronted with a body that is changing in ways nobody warned them about.

There is the physical pressure, a strange bulge between the legs, a feeling urgency and discomfort.

Then there is the grief of it of knowing that something has changed forever.

For some, there is real fear.

I have felt this fear but after doing more research, understanding more about how to exercise, eat and move I have come to a place of acceptance....and I want to help others attain this also.

WE ARE NOT BROKEN

This is the thing I most want to say. A prolapse is not a failure or a punishment. It is not the end of a full, physical and wonderfully fulfilling life. It is only the body asking for attention, nourishment, and support in a different way.

Actually, Chinese medicine has been offering exactly this support for over two thousand years.

In my second post in this series, I'll go into what TCM treatment for pelvic floor prolapse actually looks like. What are the acupuncture points and principles involved here and what are the herbal strategies, the lifestyle and dietary recommendations. Also, how can these approaches work alongside pelvic floor physiotherapy and other Western approaches.

We need to know that there is a great deal that can be done. And women deserve to know it.

Please know you are not alone in this. Do not suffer in silence and fear. Please reach out to health professionals, whether that is me, your GP or a pelvic floor physiotherapist.

Jenny Swan practises acupuncture, TCM herbal medicine, and bodywork in mid-Devon. She works with women across all stages of life, with a particular interest in menopausal issues.

Part 2 of this series: Lifting the Qi — TCM Treatment Approaches for Pelvic Floor Prolapse and Menopause