Status: Individual funding approval
Effective date: 1 April 2026
Next review date: 1 April 2031
Pelvic organ prolapse occurs when one or more of the pelvic organs descend into the vagina, causing a range of symptoms.
Essex ICB will only fund surgical interventions for Uterovaginal Prolapse in the following circumstances:
- In cases of mild to moderate symptomatic cystoceles where trial of a vaginal ring pessary has failed
- In cases of mild to moderate symptomatic rectoceles
- In severe cases of prolapse or procidentia
Watchful waiting, with observation for the development of new symptoms or complications is appropriate if the prolapse is minimal (Stage I), or asymptomatic.
Prolapse staging should be assessed using POP‑Q or equivalent standardised system
Referral for specialist assessment for surgical interventions will only be funded when the following criteria have been met:
- Lifestyle interventions should be tried as per NICE guidance. These include avoidance of constipation, avoidance of heavy lifting and weight loss if BMI is greater than 30).
- A trial of supervised pelvic floor muscle training for at least 3 months (only in women with stage 1 to 2 prolapse).
- A trial of topical vaginal oestrogen in appropriate patients. For information on choice of products, please see Medicines Optimisation
- A trial of vaginal ring pessary in appropriate patients. Trial and ongoing management of pessary can be undertaken in primary care.
Use of mesh (synthetic) is not funded. Current evidence on the safety of transvaginal mesh repair of anterior or posterior vaginal wall prolapse shows there are serious but well-recognised safety concerns. Evidence of long-term efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. NICE IPG599
Women should have sufficient understanding of their treatment, including the benefits, potential risks, and alternative treatment options, including doing nothing.
For women considering surgery, the use of appropriate patient decision aids is highly recommended:
- Surgery for uterine prolapse: patient decision aid and user guide
- Surgery for vaginal vault prolapse: patient decision aid and user guide
| Clinical scenarios where surgery will not be routinely funded | Clinical scenarios where referral for specialist assessment is necessary to determine suitability for surgery |
|---|---|
| Asymptomatic pelvic organ prolapse | Failure of pessary |
| Mild pelvic organ prolapse (unlesscombined with urinary/faecalincontinence) | Women with symptomatic prolapse (including those combined with urethral sphincter incompetence or faecal incontinence) |
| Prolapse combined with urethral sphincterincompetence/ urinary incontinence or faecalincontinence | |
| Women with moderate to severe prolapse who want definitive treatment |
Patient information:
Pelvic organ prolapse Policy (continued)
Funding for patients not meeting the above criteria will only be granted in clinically exceptional circumstances.
Further information about applying for funding in exceptional clinical circumstances can be found on the ICB website.
Reference:
Urinary incontinence and pelvic organ prolapse in women: management.
NICE guideline [NG123] Published: 02 April 2019 Last updated:24 June 2019