Prolapse

There are a number of different types of Prolapse that may or may not affect a woman’s need for a hysterectomy. They are referred to by the wider term of ‘genital prolapse’ which includes several conditions, these can occur separately or together and they may occur to differing degrees. These include uterine prolapse (dropped womb), vaginal prolapse, cystocele (dropped bladder), rectocele (dropped rectum), and enterocele (hernia of the small intestine into the space between the rectum and vagina).

Uterine prolapse or dropped womb is a condition in which the uterus drops downward in the pelvis below its normal position. The uterus may drop slightly and remain above the vagina It may drop further so that the cervix or lower portion of the uterus reach into the vagina. In its worst form, the cervix or even the entire uterus will drop out of the vagina.

All prolapse occur when the muscles and ligaments holding these organs to the bones of the pelvis in place become weak. Stretching and slackening is a natural result of childbirth and also takes place as you get older. When the muscles and ligaments no longer work the uterus and vagina will sag down and a bulge of the bladder or rectum may occur in the front or back wall of the vagina. It can also occur due to a thinning of the muscles at the time of the menopause which, in turn, is caused by a drop in the female sex hormones. Another common cause of prolapse is obesity which can add additional stresses to an already weak system of support, extra weight will press on the bladder.

Occasionally prolapse may occur if there is an inherited weakness of the pelvic floor muscles. The most common types of delivery to cause problems with prolapse are those that are protracted, are for large babies or use forceps or a vacuum extraction. Occasionally heavy lifting, chronic coughing or constipation can also be cited as reasons for later prolapse in the abdominal region.

Certain types of prolapse can lead to varying levels or severity of urinary incontinence. The different types of incontinence include:

• Stress incontinence where urine is leaded when you cough or sneeze or laugh for instance.
• Urge incontinence where you feel a need to go to the toilet more frequently than necessary
• Overflow incontinence where the bladder fills and is not emptied properly
• Total incontinence where there is a constant loss of urine.

Symptoms

• lump or bulge inside or outside the vagina
• feeling of pressure in the vagina
• recurring bladder infections
• backache in the lower back
• disturbance of bowel movements
• need to urinate more frequently
• incontinence to varying degree

What Treatment is Available?

The most common Drug Treatment is the use of hormone replacement therapy which is used to help restore the strength in the ligaments and muscles.

Surgical Treatment (Alternatives to Hysterectomy)

Surgical treatments are used to repair and restructure the ligaments and muscles and will depend on the type and amount of prolapse that has occurred. It includes vaginal repairs which involves the vagina being cut and folded over to create additional support. However, such repairs may impact on sexual activity, particularly where the vagina is narrowed or shortened.

Vaginal suspension (utero colpo sacro pexy)will use netting or leather to attach the top of the cervix or vagina to the top of the pelvis.

A Manchester procedure which partially amputates the elongated cervix and shortens the ligaments which support the uterus in its normal position.

What Treatment is Available?

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