Prolapse of uterus and other pelvic organs
Prolapse of the uterus (womb) and other pelvic organs (urinary bladder and rectum) is very common.
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Normally these structures are held in place by ligaments and muscles in the bottom area which make up the 'pelvic floor'.
As you get older your muscles can get a bit weak. Prolapse is more frequent in older women, particularly after menopause. ​Pregnancy and childbirth can weaken the pelvic floor, especially when your baby was large, or you had more babies or your labour was prolonged or required a 'forceps' or 'vacuum' instrument to deliver your baby. Chronic constipation can make you strain at stools regularly which in turn can weaken the pelvic floor muscles and cause prolapse. Chronic cough (e.g.smokers) can also weaken the pelvic floor and cause prolapse.
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Prolapse may involve one or more pelvic organs.
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When the urinary bladder bulges into the front wall of the vagina, it is called anterior (front) wall prolapse or cystocele.
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When the rectum bulges in the back wall of the vagina, it is called posterior (back) wall prolapse or rectocele.
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When the womb bulges into the vagina from the top, it is called uterine (womb) prolapse.
In some patients, after hysterectomy, the top portion of the vagina (vault) may bulge into the lower part, it is called vault prolapse.
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Sometimes more than one pelvic organ mentioned above may prolapse, in the same person.
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Most patients with prolapse have no symptoms. Therefore treatment may not always be necessary. However, some patients do experience symptoms. They could benefit from treatment. A detailed consultation by the gynaecologist is useful. The common symptoms include
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Prolapse can cause discomfort or a feeling of heaviness.
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It can be noticed as a lump coming down in the vagina, from the front (cystocele), back (rectocele), or top (uterine or vault prolapse).
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It can cause bladder symptoms such as urgency, urine leakage (incontinence) and infections
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It can cause bowel problems
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It can affect sexual activity by causing a feeling of looseness or loss of tone
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Cosmetic concerns. Even when not causing other symptoms, the appearance may be of significant concern to some women.
Treatment:
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Lifestyle changes​
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Avoid heavy lifting
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Steps to treat constipation by altering your diet, fluid intake or fibre supplements (e.g. psyllium husk). Laxatives may be needed as recommended by your doctor
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Physiotherapy: These are specific exercises to strengthen your pelvic floor. Guidance from a physiotherapist may be required.
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​Pessaries: A vaginal pessary is a plastic or rubber ring which is inserted into the vagina to support the weak and bulging tissues. A pessary must be removed regularly for cleaning. It is very important to fit the correct size of pessary to control symptoms. Pessary needs to be changed or it can be removed, cleaned and reinserted periodically to avoid infection. If you are unable to do it yourself, your doctor or a clinic nurse can always do it effectively.
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Surgery: is not required if you do not have symptoms related to prolapse or if lifestyle changes, physiotherapy or pessaries improve your symptoms. It also depends on the type of prolapse and its severity. It is very important to have a clear understanding of the benefits and risks of surgery and a frank discussion with your specialist.
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Surgery for prolapse is intended to support the pelvic organs so that your symptoms improve. It may not always cure the problem completely. There are a number of possible operations; the most suitable one for you will depend on your circumstances. Broadly, there are two types of surgeries.
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Vaginal Repair: This involves repairing the weak portion of the pelvic floor, by removing the loose tissues and tightening the vaginal wall by stitching. This may be 'anterior repair' to treat an anterior (front) vaginal wall prolapse or 'posterior repair' to treat a posterior (back) vaginal wall prolapse or a combined anterior and posterior repair if there is prolapse involving both walls.
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Vaginal hysterectomy: If the womb has prolapsed repair is not feasible and the uterus would need to be removed.
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Both the above surgeries are done through the vagina and will not result in any visible scars.
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