PELVIC ORGAN PROLAPSE

Pelvic organ prolapse, also known as vaginal prolapse, is bulging of one or more of the pelvic organs into the vagina, and may affect the front, top or back of the vagina depending on the organ prolapsing. The organs that can prolapse are the bowel, bladder, uterus, and the top of the vagina (vault) after a previous hysterectomy. The main types of prolapse are:

Cystocele when the bladder bulges through the front wall of the vagina

Prolapse of the uterus and cervix  when the womb descends lower in the vagina

Rectocoele and enterocoele when the bowel bulges through the back wall of the lower and upper vagina respectively

It is possible to have more than one of these types of prolapse at the same time.

Prolapse can occur with increasing age, especially after menopause, childbirths, chronic straining as with chronic cough, chronic constipation, repeated heavy lifting and manual work.

SYMPTOMS

Include sensation of a bulge or something coming down or out of the vagina, discomfort during sex, problems passing urine such as slow stream, a feeling of not emptying the bladder fully, needing to pass urine more often and leaking a small amount of urine on coughing, sneezing or exercise, or incomplete bowel evacuation.

Some women with a prolapse don’t have any symptoms and the condition is only discovered during an internal examination for another reason such as a cervical smear. Vaginal prolapse is not life threatening but can affect quality of life.

MANAGEMENT

Includes pelvic floor muscle training, physiotherapy, local estrogen if postmenopausal, ring pessary when surgery is not appropriate or is declined.  Surgery is indicated when conservative methods fail, and may include repair of the anterior vaginal wall for a cystocele or repair of posterior vaginal wall for rectocele and enterocele, repair of perineum and vaginal hysterectomy, in varying combinations depending on the nature of prolapse.