A Deep Dive into Prolapse

Feeling something dripping down in your vagina? You are not alone. Prolapse is common with age. While it is not life-threatening, these symptoms can affect one’s quality of life.

Women are often left to cope alone with a sense of shame. Urogynaecology focuses on pelvic floor disorders in women. A urogynaecologist is a gynaecologist with advanced training in pelvic floor medicine and reconstructive surgery.

What is pelvic floor?

The pelvic floor is a group of muscles and ligaments that support the bladder, bowel, and womb. Damage to this area can cause conditions like prolapse of the womb, bladder, or bowel, as well as issues such as urinary incontinence and recurrent urinary tract infections (UTIs).

Pelvic organ prolapses

Nearly half of women above the age of 50 have some degree of vaginal prolapse. This occurs when the pelvic organs slip down into or out of the vagina.

Types of prolapses

1. Uterine prolapse: Prolapse of the womb into or out of the vagina.

Symptoms:

• Feeling a lump in the vagina while walking and sitting
• Pulling or heavy sensation
• Discomfort during sexual intercourse
• Difficulty inserting tampons

2. Cystocele: Prolapse of the bladder into the front wall of the vagina.

Symptoms:

• Feeling a lump in the vagina while walking and sitting
• Difficulty emptying the bladder completely
• Recurrent UTIs and frequent urination

3. Rectocele: Prolapse of the rectum pushing into the back wall of the vagina.

Symptoms:

• Feeling a lump in the vagina or anus
• Some may face difficulty passing stool

4. Vaginal vault prolapse: Prolapse of the top of the vagina after a hysterectomy.

Symptoms:

• Feeling a lump in the vagina while walking and sitting
• Difficulty emptying the bladder and bowels completely

Common causes

• Pregnancy and childbirth: Weight from pregnancy and hormonal changes can increase pelvic ligament laxity, while vaginal birth can damage the pelvic floor muscles.

• Menopause: Reduction of oestrogen after menopause results in alteration of the muscle fibres strength in the pelvic floor.

• Collagen disorders: They have a genetic component that alters ligament structure, making them laxer and more prone to

• Obesity: Increases the pressure on the pelvic floor that leads to weakening it.

• Chronic constipation and cough: Places repeated strain on the pelvic floor making it more susceptible to prolapse.

Type of treatments

1. Lifestyle modifications

Treating cough and / or constipation, encouraging weight loss, and reducing heavy lifting help prevent the prolapse from getting worse. Pelvic floor muscle exercises strengthen the muscles and improve support for the pelvic organ.

2. Medical wearables

Vaginal pessaries are rubber or silicone devices inserted into the vagina to support the vaginal walls and pelvic organs. They are a non-surgical option for women who prefer non-surgical methods. These need to be removed and replaced by a gynaecologist two to three times a year.

3. Surgery

This is a recommended option if non-surgical ones are ineffective or the cis severe. It can be performed vaginally or laparoscopically, and may include procedures such as vaginal wall repair, vaginal hysterectomy, uterine-preserving surgery, or closing the vagina.

Your urogynaecologist will discuss the benefits and risks, and create an individualised care plan for you.

Prevention of prolapse

1. Maintain a healthy body weight
2. Perform pelvic floor exercises daily
3. Increase dietary fibre
4. Avoid activities that put extra pressure on your pelvic floor
5. Stop smoking

When should you see a urogynaecologist?

You should seek help when your symptoms start to negatively impact your quality of life. Urogynaecologists want to help women with these symptoms: it is our raison d’etre (reason for being) after all.