What is prolapse?
Prolapse occurs when the walls of the vagina lose support. This can cause the organs and spaces around the vagina to bulge downwards. The symptoms or complaints that an individual might have in this situation vary widely.
Up to 40% (4:10) women attending a general gynaecology clinic may have some degree of prolapse, but many will be asymptomatic. Around 1:4 women in the western world will undergo some sort of procedure for prolapse or incontinence in their lifetime.
The biggest risk factor is vaginal birth, and in particular forceps use with associated injury to the pelvic floor muscles which provide a lot of support to the vaginal walls and the organs behind them.
It is important to note that pregnancy itself is a risk factor, and that elective Caesarean section will not necessarily prevent all prolapse.
Some women who have never been pregnant can develop prolapse as well. Being overweight, smoking and/or a chronic cough, constipation with straining, repetitive high impact activities and going through menopause are all associated risk factors.
The commonest symptom is the sensation of a bulge, or an awareness that something ‘doesn’t’ feel right’.
Many women say they first became aware of it when washing, or could feel a sense of ‘obstruction’ with tampon placement or sex. In others, the organ that is ‘behind’ the bulge begins to function differently. For example, some people develop difficulty with emptying the bladder or bowel, or need to go back for another go.
Incontinence (of urine or bowel contents) may be associated with prolapse, but the prolapse may not be the cause and this needs to be borne in mind if surgery is planned.
Sometimes women describe pain or discomfort, often experienced as a dragging feeling in the lower back, and that may be relieved by emptying the bladder or bowel, or lying down so the prolapse reduces.
Others find they need to splint the vaginal wall with a finger, or support the perineum (between vaginal and anus) to empty the bowel.
The symptoms can be quite variable, but broadly reflect how much bulge there is, and which organ(s) have lost support.
The vagina is of course a very important structure as well, so be sure to discuss any issues or concerns you have with sexual function when you see your specialist.
A variety of different procedures can be done to correct prolapse. These include vaginal surgeries using long lasting dissolving stitches to provide support. Permanent stitches and sometimes hysterectomy may also be required. Laparoscopic surgeries can also be done, including sometimes a laparoscopic mesh repair.
How we can help
For more information about prolapse, incontinence and different treatments that could be offered, please see the links below: