Prolapse is a descent of the vagina or/and uterus, i.e, the dropping of vagina and the
uterus is called prolapse. It's very common, particularly in women who have had children
and who have gone through the change. Prolapse happens because of the weakness of the pelvic
floor muscles and the connective tissue around it. There are different ways of treating the
prolapse and it's not anything that is dangerous or serious, but it can affect your quality
of life. And there's no reason why women should consider is as a part of being a woman. They
should come and see their doctor and get it assessed and treated. Different women can
have different degrees of prolapse and different types of prolapse. You can have either prolapse
of the womb, uterus or you can have the prolapse of the anterior wall of the vagina, which
is also known as the bladder prolapse. You can have the prolapse of the posterior wall
of the vagina; which is known as the bowel prolapse. You can have either only one of
them, or you can have combination of more than one type of prolapse.
Posterior vaginal wall prolapse is the dropping down or descent of the posterior wall of the
vagina. It is also known as the bowel prolapse, because as the posterior wall of the vagina
descends inside the vaginal cavity, the bowel also descends into the vaginal cavity. It
can be really uncomfortable, particularly when your bowels are full. If the posterior
vaginal wall prolapse is big, once you try to empty your bowels, you'll find at the bowels
instead of coming out, it goes into this pouch, and some women put their finger inside the
vagina to facilitate emptying of bowels, which we call as digitation to defecate. Posterior
vaginal wall prolapse is caused because of the weakness of the pelvic floor muscles and
it's common in women with chronic constipation, because when you're trying to open your bowels
with the constipation, it pushes the wall of the vagina and causes prolapse. There are
different things that you can do to treat the posterior vaginal wall prolapse, and the
most important is to avoid constipation. Try not to lift too heavy weight and if you are
overweight, try to reduce your weight. You need to see your doctor if you are suffering
with posterior vaginal wall prolapse, particularly if you are needing to put your finger inside
the vagina to empty your bowels. It will get progressively worse if you do not put any
action in place.
The main causes of prolapse are number one: childbirth, number two is menopause. Because
of both of these reasons with the childbirth and with the change, the pelvic floor muscles
and the connective tissue around it becomes weak. The pelvic floor muscles are like a
trampoline that holds womb, vagina, bladder and bowels up. Once we have children or we
go through the change, it becomes like a hammock. So that is how I explained it to the patients.
The trampoline becomes a hammock, i.e, the pelvic floor drops down. As a result of that,
the womb drops down and the bladder drops down and the bowels drop down, which we call
prolapse. The other things that can cause prolapse are constipation. If you suffer with
chronic constipation, and you're pushing to open your bowels that can again damage our
pelvic floor and lead to prolapse. Chronic cough can also lead to prolapse and if we
are overweight, that can also cause prolapse. That is the first thing we need to do if you
have a prolapse and your weight is on the higher side; you're overweight, you need to
reduce your weight to prevent the prolapse from getting worse and causing problems.
The symptoms of prolapse are quite variable. They depend upon the degree of the prolapse
and the type of the prolapse you have. The common symptoms that you can feel with the
prolapse or you feel as if you're sitting on an egg that is what women will commonly
describe that, we feel like we are sitting on an egg, but usually towards the end of
the day or if they have opened their bowels. You can also get dragging sensation in the
vagina, fullness in the vagina, discomfort in the vagina. Sometimes you can have discomfort
during sexual intercourse, because of the prolapse and if you have a bladder prolapse,
you can have bladder symptoms which can be difficulty in emptying bladder. You go and
empty your bladder and you feel that you can't empty it completely, and once you have emptied
your bladder, you get up and you dribble a little bit. That is because you haven't emptied
the bladder completely because of the prolapse. Bladder prolapse can also cause frequency,
which means that you go too often during daytime to empty your bladder. You go a lot during
night also to empty your bladder that can also be a symptom of prolapse. You can have
urgency. When you need to go, you need to rush to toilet. That can also be a symptom
of bladder prolapse. You can have difficulty emptying your bowels particularly with the
bowel prolapse and you can sometimes need to push your finger inside the vagina to reduce
the prolapse to enable you to empty your bladder or to empty your bowels. Very occasionally,
prolapse can cause bleeding when it's outside and it's rubbing on the underwear. Some women
will have no symptom at all with the prolapse and the prolapse is incidentally found during
examination, particularly during the cervical smear.
There are different ways of treating the prolapse and it is not necessary that you will need
a treatment, but I would suggest to see your GP if you suspect that you have a prolapse.
They will discuss the treatment options with you. If your prolapse is not causing any symptoms
and is not coming out completely, your GP will recommend you to do the pelvic floor
exercises. That will not take the prolapse back, but it will prevent it from getting
worse. If you're overweight, they will advise you to reduce the weight. It is only when
the prolapse causes symptoms, they will offer you definitely to treatment, which can either
be a pessary or surgery. Pessary is vaginal devices that are placed in the vagina to hold
everything up. They can be put in by your GP, or the GP can send you to the hospital
to see a urogynecologist, the specialists in this field to put a pessary in. Pessary
has got hardly any complications, but it needs to be changed every six weeks, and if that
is not the option that your doctor thinks is good for you or if that's not the option
that you want, then the doctor will send you to the hospital and they will offer you surgery.
The surgery for the prolapses are quite simple and they are not very high risk and you recover
quickly from them and the outcomes are quite good.