What is a Prolapse?

A prolapse is a medical condition where an organ or tissue falls down or slips from its normal position. This occurs when the pelvic floor muscles and connective tissue that support the pelvic organs are weakened.

A pelvic organ prolapse is a condition that occurs when the structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself falls out from their normal position.

Causes of Vaginal Prolapse

The main cause of vaginal prolapse is the weak muscles, tissues, and ligaments that support the vagina, surrounding tissues and organs.

The factors that can cause vaginal prolapse include

  • childbirth,
  • menopause,
  • frequent lifting of heavy objects,
  • chronic cough,
  • severe constipation.

Symptoms of Utero-Vaginal Prolapse

A woman with a mild prolapse may not experience any symptoms. However, women with more severe forms of prolapse may experience:

  • Sensation of pulling or pressure in the lower abdomen or pelvis
  • An uncomfortable feeling of fullness in the vagina
  • Low back pain
  • Urinary problems, such as urine leakage or urine retention
  • Difficulty in urinating and emptying bowel
  • Urinary tract infections
  • Vaginal bleeding or discharge
  • Discomfort during intercourse

Diagnosis of Utero-Vaginal Prolapse

Dr Mariud will diagnose the condition by taking a detailed history and performing a physical examination. During the examination, you may be asked to cough or bear down. 

Treatments for Pelvic Prolapse

Treatment options include

  • Pelvic floor exercises
  • Lifestyle changes - to avoid heavy lifting, constipation
  • Local oestrogen treatment
  • Pessary, a removable device fitted in the vagina to reduce pain and pressure of pelvic organ prolapse.

If the non-surgical treatment does not reduce the symptoms of pelvic organ prolapse, then surgery is considered. There are several types of surgeries to correct different types of pelvic floor prolapse.

The surgery can be performed laparoscopically or through the vagina, depending on the nature of the prolapse.

Surgical Treatments for Pelvic Floor Disorders

There are different types of procedures to address a specific prolapse. The aim of pelvic floor reconstruction is to restore normal anatomy and function of the pelvic organs.

Dr Mariud will discuss with you the laparoscopic surgical options such as

  • Laparoscopic Pelvic Repair, and
  • Vaginal Pelvic Floor Repair.

Dr Mariud has expertise on pelvic floor repair.

ANTERIOR COLPORRHAPHY

This is a vaginal procedure to address a moderate degree of cystocele. The anterior vaginal wall is opened to reveal the bladder prolapse. The prolapse is reduced and held in place with a ladder of slowly absorbing sutures. The vaginal skin is closed with a rapidly absorbing suture. This procedure takes about30 minutes to perform. You will be in hospital overnight. You will return to normal activities after about 2-3 weeks. Dr Mariud will see you one week after discharge from hospital to monitor your progress.

POSTERIOR COLPORRHAPHY

This is a vaginal procedure to address a moderate degree of rectocele. The posterior vaginal wall is opened to reveal the rectal prolapse. The prolapse is reduced and held in place with a ladder of slowly absorbing sutures. The vaginal skin is closed with a rapidly absorbing suture. This procedure takes about30 minutes to perform. You will be in hospital overnight. You will return to normal activities after about 2-3 weeks. Dr Mariud will see you one week after discharge from hospital to monitor your progress.

PERINEORRAPHY

This is a vaginal procedure performed to treat a gaping introitus. A small incision is made at the posterior introitus and minimal dissection performed at the perineum. Sutures are placed to build up the perineal body and treat the gaping introitus.

This procedure takes about30 minutes to perform. You will be in hospital overnight. You will return to normal activities after about one week. Dr Mariud will see you one week after discharge from hospital to monitor your progress.

SACROSPINOUS COLPOPEXY

This is a vaginal procedure to elevate the vaginal apex to the sacrospinous ligaments. It is performed in conjunction with a posterior colporraphy. It takes about 45 minutes to perform.  You will be in hospital for two days. You will return to normal activities after about 2-3 weeks. Dr Mariud will see you one week after discharge from hospital to monitor your progress.

Complications of Vaginal Prolapse Surgery

Every surgical procedure may be associated with certain risks and complications. The possible complications after the surgeries for vaginal prolapse include pain, infection, bleeding, recurrence of symptoms, injury to ureters, and perforation of rectum and bladder.

The complications are usually mild and can be treated accordingly.

The advantages of choosing minimally invasive surgery is that the defects can be clearly identified, incisions are small, postoperative pain and discomfort are reduced, shorter duration in hospital, and quicker recovery.

Post Operative Expectations

Most women will require some form of oral analgaesia for about one week. Constipation is very common after pelvic floor repair procedures.

Dr Mariud will give specific advice to help you to address this problem. You are advised to avoid heavy lifting and straining for at least 3 months.

Dr Mariud will arrange for you to be reviewed by physiotherapist with a special interest in pelvic floor disorders. Ongoing pelvic floor exercises and lifestyle modifications to avoid heavy lifting will ensure a long term cure.

Dr Mariud may also recommend ongoing use of an oestrogen cream which is known to enhance tissue strength and promote healing.

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