Prolapse means to fall out. Commonly the term prolapse is used to describe when a bulge develops in the vagina. This can be of the front wall, central compartment (womb or top of the vagina in someone who has had a hysterectomy) or back wall. Some degree of prolapse is extremely common in women who have given birth. The vast majority of them do not require any treatment and do not cause any problems.
What is prolapse?
Prolapse is caused due to the loss of support most commonly caused by changes to the tissues of the pelvis through the weight of pregnancy or due to damage from stretching or tearing during childbirth.Several factors affect this. If the tissues are too rigid then they may give way by tearing (more commonly seen after forceps or ventouse deliveries) or because the tissues are more stretchy. Often symptoms are temporary after delivery as the body heals. However once tissues are damaged they seldom return completely to the pre-pregnancy state and often may slowly deteriorate. Problems may be exacerbated by other problems, especially constipation.
How do you know if you suffer from prolapse?
Prolapse most commonly causes presents as a bulge where the woman becomes aware of a lump in the vagina. This may be “reducible” so that it is more noticeable at certain times such as later on in the day or after exercise. It may also come down on straining so be noticeable when going to the toilet.
Prolapse can also commonly cause backache. If the prolapse is more marked then it can rub and become sore, but prolapse does not usually cause pain.
Treating a prolapse
There are several approaches to treating prolapse. As with most things lifestyle changes may help. Loosing weight in someone who is overweight can help, as can treating other conditions such as constipation or a chronic cough. There is good evidence that physiotherapy can help, particularly in less severe cases.
In women who want to avoid surgery there is the option of a supporting device, most commonly in the form of a ring pessary. There are a number of alternative pessary devices available.
Surgery is usually tailored to the individual needs, based on age, symptoms and individuals wishes (e.g. avoiding hysterectomy). Details of the various operations can be found on the British society of Urogynaecology website under the patient information page.
What to expect at your first appointment
At your first appointment your symptoms will be assessed and an examination undertaken to confirm the exact type of prolapse. Pelvic floor symptoms are often complex and interrelated and as such careful evaluation required.Often you will be asked to complete a bladder diary and a quality of life questionnaire (ePAQ). It is possible that you may require some investigation such as an ultrasound or Urodynamics. The management options will be outlined and you will receive an individualised letter outlining the discussion to help you decide what is best for you.
Surgery for prolapse is about improving the patient’s life and as such you will be central to the decision about what treatment.
Currently many women are worried about the use of mesh in surgery. You can be reassured that mesh is seldom if ever used and that you have to give consent to any procedure. No mesh implant can be used without your explicit consent after discussing all the risks, benefits and alternatives before surgery. Almost every operation which uses mesh has a non mesh alternative.