Childbirth is the most common cause and the more children women have vaginally, the more likely they are to develop a prolapse. However, there is evidence that prolapse may be partly inherited and may run in families and this may be due to some form of connective tissue weakness. The menopause may also play a part as does chronic straining such as with constipation or with a chronic cough.
Treatment is aimed at the symptoms. First of all, if a woman is post-menopausal and the vagina is dry, vaginal oestrogens can be given to improve tissue quality. For certain types of prolapse, particularly uterine prolapse, if the patient is unfit for surgery or does not wish to have surgery then a vaginal pessary (support device) may be used. There are a variety of types and some are fitted for up to six months at a time and some may be inserted and taken out on a daily basis. Usually, the commonest treatment is surgery.
Surgery for uterine prolapse usually involves hysterectomy but we can offer surgery to preserve the uterus in some women who do not want a hysterectomy and this is particularly important for those who have not completed their families.
Surgery for anterior or posterior wall prolapse has been simplified and women recover quickly. This can be performed as a day case under a local, epidural or general anaesthetic. Women can usually drive after a week and be back to full normal activities soon afterwards and there is no long-term restriction to activities. Most of the symptoms of prolapse improve and this includes urinary symptoms, bowel symptoms and sexual dysfunction.
