Prolapse

Prolapse occurs when there is weakness involving the support structures that hold the uterus and/or vaginal walls in place.

• If the front wall of the vagina is weakened this can cause the bladder to protrude/prolapse into the vagina
• If the back wall of the vagina is weakened this can result in bowel protruding/prolapsing into the vagina
• If the ligaments that support the uterus are weakened the uterus can push/prolapse into the vagina

Symptoms of prolapse include:

• A dragging sensation in the lower abdomen and pelvis with backache
• An awareness of a lump at the entrance to the vagina which can be felt or seen
• Urinary symptoms such as stress incontinence (involuntary leakage of urine with coughing, sneezing, laughing or exertion)
• Bowel symptoms where a woman may need to put a finger on her perineum (outside of vagina) or on the back wall of the vagina to allow a bowel motion to occur
• Causes of prolapse include childbirth and getting a little older. However as prolapse does not occur in all women, we are sure there is a genetic component where the structures involved in supporting the vagina and uterus are weaker than usual (there may be a family history).

In general terms prolapse is an all or nothing phenomenon and if one area of the vagina is weakened, then other areas are often weakened also. When a woman presents with symptoms of prolapse it is important to identify all areas that are weakened.

Management of Prolapse:

Prolapse can be managed in a number of ways.

Ovestin pessaries:

This is a weak oestrogen (17 Beta Oestradiol) given as a vaginal pessary. When used twice weekly it can revitalise the superficial skin layers in the vagina and bladder. It takes up to six weeks for the Ovestin to work efficiently and is worthwhile using long term.
This is not hormone replacement therapy.

Physiotherapy:

Physiotherapy can markedly improve prolapse symptoms as well as symptoms related to urinary urge and stress incontinence. Jill Wood and Vicki Holmes are two experienced Women’s Health Physiotherapists based at Birthcare.

Ring Pessary:

A ring pessary is a round vinyl ring inserted into the vagina to improve prolapse and urinary symptoms. The pessary needs to be changed every six months to avoid vaginal inflammation. It is used mainly in those women who are not suitable for surgery.

Surgery:

Surgery for prolapse varies depending on the degree of uterine and vaginal involvement.

If there is prolapse which involves the front and/or back walls of the vagina or vaginal vault, it is usually repaired vaginally.

If a woman has finished her family and the uterus has descended to the entrance of the vagina, then a Vaginal Hysterectomy is often performed. This involves removal of the uterus (with conservation of the ovaries) through the vagina. This can be combined with repair of any vaginal prolapse. 

Patients can usually choose whether to have a spinal (like an epidural) or general anaesthetic (being put to sleep). A spinal anaesthetic provides excellent pain relief without needing to be put to sleep. The surgery takes approximately 90-120 minutes and the hospital stay is usually 3-4 days with return to work after 4-6 weeks on average.

Heavy lifting should be avoided for 6-12 weeks after surgery. This is important to allow the stitches used to repair the prolapse to do their work.

The risks related to this sort of surgery are low and significant complications are unusual. With the best of intentions and good operative technique there will still be a group of women who will develop recurrent prolapse. If a woman with recurrent prolapse requires further treatment, surgery involving the use of mesh may be advised.