What is a prolapse I hear you ask? And how does a woman get one?
This indeed is a very common problem. For many, the only time they find this is when they feel a lump in the vagina. It can be very frightening when you find it for the first time.
Well, it is not the world falling out of your bottom! But it can feel like it sometimes. Essentially it is like a hernia. This is due to the pelvic floor muscle and ligaments not being strong enough to hold the contents of your pelvis namely the bladder, bowel, womb inside your tummy. So they fall down and out!
Prolapse is due to a combination of pregnancy and gravity. The pregnancy and subsequent vaginal delivery lead to damage to the pelvic floor muscle, ligaments and nerves. Humans are bipedal creatures, meaning we stand on 2 legs walking around. Over time with the damage done, the pelvic organs start to fall down the vagina. Given that most women are involved in caring for children, doing the house work with cleaning, lifting washing etc, the effect of these activities aggravates the prolapse. These days it is common to see many women undertake exercises especially at the gym. Weight lifting, high impact exercises, if not undertaken appropriately also can worsen prolapse. With menopause, the loss of hormones will weaken the muscle and ligament tone, further accentuating it. Gravity pulls the organs down further until one day, a lump appears outside the vagina.
Do you know that there are potentially 5 different prolapses a woman can have….yes, 5 (FIVE). As if one is not enough. They are:
- Prolapse of the urethra – urethrocoele
- Prolapse of the bladder – cystocoele
- Prolapse of the womb
- Prolapse of the bowel – enterocoele
- Prolapse of the rectum – rectocoele
Whilst they are separate types, commonly they co-exist. However, one may be more prominent than another and how they are treated will depend on the symptoms and the severity of the prolapse. Symptoms will vary depending on the type and combination of prolapse present. The can include:
- Sensation of a lump outside the vagina
- Bladder symptoms – urgency, frequency, waking up at night, incontinence
- Bowel symptoms – incontinence of bowel or wind
- Back pain
- Dragging sensation in the lower tummy or vagina
It is common to see a degree of prolapse in any woman who has had a baby especially if the birth is vaginal. However, not all prolapses need treatment. Some are very mild. These are best left alone unless they have symptoms.
How does one manage a prolapse? The mainstay is to consider:
- Pelvic floor exercises
- Minimisation of straining.
- Bowel management especially avoidance of constipation
- Weight management to maintain normal body weight.
Pelvic floor exercises are best taught by specialist pelvic floor physiotherapists. They are specially trained in assessing pelvic floor muscle strength and function. Usually they will initiate pelvic floor muscle exercise regimes to try to improve their strength. In addition, many will assess core muscle function as these also are important.
Strengthening of the pelvic floor can also be undertaken by magnetic therapy. A very useful adjunct to pelvic floor physiotherapy, it offers a safe an simple method for many women to enhance their pelvic floor muscle strength and tone. I have found this very helpful for mothers in the postnatal period, where they may diffiulty in doing pelvic floor exercises due to pain or loss of sensation to their pelvic floor following childbirth.
Should there be other symptoms present then they will need to be investigated and managed accordingly. For example with:
- Bladder symptoms, one may need to consider
urodynamic studies which include a cystoscopy to check bladder function
pelvic ultrasound to check bladder support
urine culture to exclude infection or inflammation - Bowel symptoms may require:
anal manometry and ultrasound to check anal sphincter tone and integrity
colonoscopy and or sigmoidoscopy
nerve studies
For many, conservative treatment as outlined above, is all that is required. However, if there are significant bowel or bladder problems or the prolapse is too large to be managed conservatively then one may have to resort to either:
- Vaginal pessary. This is a plastic device which is inserted into the vagina and keep in place continuously. It helps to hold up the prolapse and may also alleviate some of the bladder or bowel symptoms if mild.
Or
- Surgery. This is the mainstay of most prolapse therapy. It helps to reduce the prolapse, puts the pelvic organs back into their normal position in the pelvis and can be used to cure or improve incontinence.
Whilst either option can be used, the choices made will depend on the individual’s situation. It is best determined after consideration of the findings of the various investigations undertaken. It is important to realise that prolapse is a common problem especially following pregnancy and menopause. There are many options of management and women do not need to suffer this in silence.
At the Women’s Clinic here, we offer individualied holistic assessment and treatment by specialist Practitioners from Gynaecologist, Colorectal surgeon, Urologist through to Specialist pelvic floor physiotherapists to maximise the outcome for success in managing what can be a very distressing condition.
These notes reflect my personal opinion and are intended for general advice only. It should not be used for any one individual case. You should consult your own doctor to determine the appropriate management of your own individual situation.