What is a prolapse?
A prolapse of the pelvic organs affects around 20-30% of the female population. Approximately 11% of women will require surgery for prolapse during their lifetime. While a uterine prolapse is the one that you are most likely to have heard about, there are many other types, all causing different symptoms.
Treatment for pelvic organ prolapse ranges from non-surgical to surgical procedures and the type of prolapse symptoms you have usually affects the type of treatment you will receive.
Contrary to popular belief, the pelvic floor is not just made up of muscles but also ligaments, blood vessels, nerves and connective tissue. Damage to any of these structures may lead to problems with support of the pelvic organs.
Different types of pelvic organ prolapse
A prolapse of the front wall of the vagina is called a cystocele and is a prolapse of the bladder into the vagina. If the rectum bulges into the back wall of the vagina and pushes forward this is called a rectocele. If the uterus prolapses this is called uterine prolapse, and this is the prolapse most women have heard about.
Prolapse may occur after hysterectomy which may result in the vagina being turned inside out.
Click here to read about the treatment(s) involved in treating Prolapse. If you would like more information or wish to make an appointment regarding prolapse, please get in contact .
Symptoms of a prolapse
Some of these symptoms include difficulty with intercourse, the need to go to the toilet more often or more suddenly, difficulty in emptying the bladder or bowel, recurrent urinary infections and backache. The causes are as varied as the symptoms although childbirth is the main one.
If you have urinary or bowel symptoms associated with vaginal discomfort or the feeling of “something coming down” you should consult your GP who will arrange for you to see a Gynaecologist.
Prolapse may present you with symptoms that are non-specific, such as a lump and discomfort and difficulty with intercourse. It may also cause low backache, especially at the end of the day when the prolapse is at its worst or after lifting or straining.
Prolapse of the bladder into the vagina may present you with frequency, urgency and urge incontinence and with difficulty emptying the bladder and recurrent urinary infections.
Prolapse of the rectum into the vagina may cause difficulty in bowel emptying and some women may need to put a finger into the vagina or the perineum to complete emptying.
Treatment for prolapse
Essentially, different causes mean different treatments.
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.
What if you need 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.