Prolapse

Genital prolapse is the protrusion of the pelvic organs into the vagina or even outside the vagina. There are a number of different types of prolapse:

Uterine prolapse involves the descent of the uterus and cervix down the vaginal canal. In the most severe situation, the entire uterus and cervix protrude through the vaginal entrance.

Cystocele is where the tissues supporting the wall between the bladder and vagina weaken, allowing a portion of the bladder to descend and protrude into the vagina.

Rectocele is where the tissues supporting the wall between the vagina and rectum weaken allowing the rectum to descend and protrude into the vagina.

Vaginal vault prolapse occurs when the top of the vagina descends, usually following a hysterectomy.

Genital prolapse occurs due to a weakness or damage that has occurred to the structures that hold the pelvic organs in place.  The most common causes of weakness or damage include:

  • Menopause and aging
  • Increased pressure on the pelvic floor as a result of chronic cough, obesity or lifting heavy objects
  • Pregnancy and childbirth
  • Genetic and hereditary factors also play a role.

Prolapse may be asymptomatic when it is very mild. In more severe disease some of the symptoms noted include:

  • A dragging sensation, or feeling that something is falling down
  • The presence of a lump in the vagina
  • Discomfort or aching in the pelvic region or lower back
  • Urinary problem, e.g. stress incontinence, retention of urine and incomplete urination, frequent urinary tract infections
  • Bowel problems, e.g. constipation or difficulty emptying the bowel
  • Interference during sexual intercourse, discomfort or decreased sensation

A prolapse is diagnosed by physical examination of the vagina. Treatment is dependent on the type of prolapse and the severity of the prolapse. If there are no symptoms treatment is not necessary.

  • Conservative measures such as managing chronic cough or weight loss may reduce the pressure on the prolapse and improve symptoms.
  • Physiotherapy and pelvic floor exercises help to strengthen the pelvic floor and may prevent the need for surgery or in combination with surgery improve the success of the operation.
  • Pessaries are a silicone device that can be inserted into the upper vagina to provide support to the pelvic structures. The require regular changing every 3 to 9 months. When inserted properly the woman will not feel it.
  • Surgery may be required when the non-surgical options are not successful in providing symptom relief. The surgery aims to repair the weakness and return the organs to their normal positions. The surgical technique required again depends on the type and severity of the prolapse.

Following any treatment but especially following surgery it is important to continue with good habits to reduce the pressure on your pelvic floor. It is recommended to reduce or maintain weight, avoid heavy lifting and straining and to seek treatment for chronic cough.

Ongoing physiotherapy and pelvic floor exercises will also assist in preventing recurrence or worsening prolapse.

If you have any concerns regarding your pelvic, don’t hesitate to contact DR Kylie Isaacs for an assessment as the earlier the diagnosis the better the outcomes.