Prolapse

Pelvic Organ Prolapse

 

What is it? 

A bulge in the vagina due to loss of the support of the vaginal walls and/or uterus.  This condition affects women. It is like a hernia where the vagina starts to fall down. If the front wall of the vagina is prolapsing it can drag the bladder with it. If the back wall is prolapsing it can drag the bowel with it. The top of the vagina can fall down bringing the uterus - uterine or cervical prolapse. The top of the vagina can still prolapse in a woman who has had a hysterectomy. When this occurs it is called vault prolapse.  Government Patient Information Resource https://www.safetyandquality.gov.au/wp-content/uploads/2017/02/FINAL-Patient-information-resource-transvaginal-TV-mesh-Pelvic-Organ...-1.pdf

What causes it? 

It results from a weakness of the pelvic floor muscles and the supporting tissues and ligaments.  Child birth, age, straining, coughing, lifting, obesity, and genetic predisposition may all contribute.

What tests are required? 

Beyond a history and examination very few investigations are required for a patient who only has prolapse symptoms.   A bladder diary may be helpful in assessing other bladder problems.  Sometimes ultrasound is used to check bladder emptying if there are also symptoms to suggest a problem with emptying.  Urodynamics is a test on bladder function that is sometimes required to evaluate for other problems that may co-exist such as incontinence or difficulty with bladder emptying.  Some patients only have incontinence demonstrated when their prolapse is reduced in which case measures to address this at the time of prolapse surgery can be discussed, to prevent urinary incontinence following prolapse surgery.  Further evaluation of bowel function may be needed if there are bothersome bowel symptoms.

What are the symptoms?

  • A bulge at or protruding from the vaginal opening.
  • A dragging or dropping sensation in the vagina.
  • Although there are other causes, the following symptoms can occur;
    • Difficulty emptying the bladder or bowel and some women may need to push on the bulge to empty their bladder or bowel
    • Low Back ache
    • Pelvic ache, heaviness or pain

When is it treated? 

Treatment is only necessary if the symptoms are bothersome enough or there are other problems arising like problems with bladder emptying.

What are the non-surgical treatments?

  • Pelvic Floor Exercises
  • Weight reduction in overweight patients.
  • Good diet and bowel function
  • Behavioural Therapy to improve bladder and bowel emptying
  • Manually reducing the prolapse to assist bladder or bowel emptying
  • Avoiding heavy lifting or straining
  • Management of chronic cough and cessation of smoking
  • Vaginal pessaries – these are placed in the vagina to provide support.

What are the surgical options?

  • Prolapse repair via the vagina.  This avoids an abdominal incision.
  • Prolapse repair via the abdomen either open, laparoscopic or robotic (key hole).

Version: V4, July 2018

Pelvic Organ Prolapse
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