Prolapse occurs when the muscles, ligaments, and tissues that hold the pelvic organs in place weaken, allowing the pelvic organs to descend in the pelvis. Prolapse is a form of hernia, with the uterus, vaginal walls, bladder, and bowel bulging out of the vaginal opening.
With increasing age and after childbirth, particularly when a woman passes the age of menopause, it is normal for some weakness to occur and slight ‘bulging’ and laxness of the vaginal walls to occur. Prolapse is said to occur when this bulging is greater than normal.
The term ‘prolapse’ can refer to a number of different conditions. When the supports of the front wall of the vagina are weakened, the bladder can protrude through. This is called a ‘cystocoele.’ The same problem of the back wall, where the bowel bulges through, is called a rectocoele. If the upper part of the vagina allows bowel to bulge through, this is called ‘enterocoele.’ There may be descent of the uterus (womb) down the vagina as well.
Many women will have a significant amount of prolapse but have no symptoms at all. Other women may experience some of the following:
The severity and intensity of the symptoms often bears to relation to the degree of prolapse. Women with a relatively mild prolapse may have a lot of symptoms, while other women with a greater degree of prolapsed will have few symptoms. It is common for the symptoms to worsen through the day, or with prolonged standing or straining.
You may be referred to a specialist gynaecologist for care and treatment. Your gynaecologist will take a full history, seeking information about the symptoms you have and their impact on your life. You will then be examined, to determine whether any prolapse is present, and if so, what form of prolapse this is and how severe it is. In some cases, further tests such as ultrasound may be performed.
In many cases, prolapse is not severe and there are few symptoms. Women in this situation may be reassured, and encouraged to stay healthy and report further problems in the future.
Non-operative treatments may be recommended. These will include managing any medical conditions that worsen prolapse, such as constipation or chronic cough. General fitness and attention to staying within in the normal weight range are very important.
Patients may be referred for coaching in pelvic floor exercises, to improve the strength of the pelvic floor muscles. This is often undertaken under the supervision of a physiotherapist.
Since the lack of oestrogen after menopause commonly causes a thinning of the pelvic tissues, use of oestrogen – either in the vagina or as a tablet or patch – may be used in some women, where appropriate.
Women who do not respond to simpler measures may be suitable for use of a pessary.
A pessary is a plastic device that is placed in the vagina to provide support. Many women can wear a pessary for years, and have good and comfortable support of their prolapsed.
In some cases, your gynaecologist might offer surgery for management of prolapsed. Planning of surgical procedures can be complex, and needs to be discussed in detail with your gynaecologist.
Possible surgical treatments include vaginal hysterectomy (removing the prolapsed uterus through the vagina), repair of the weakened tissues of the vagina (repair procedures), and sometimes placement of synthetic meshes to replace the damaged pelvic support tissues. In some cases, these procedures may be performed with the assistance of laparoscopy.