Uterine Prolapse

What is a prolapse?

Pelvic organ prolapse occurs when the bladder, uterus (womb) or rectum (back passage) slip from their normal position in the pelvis and push against the walls of the vagina.

What causes pelvic organ prolapse?

The bladder, uterus and rectum are supported and held in place by a group of muscles called the pelvic floor.

Any damage or weakening of these muscles disrupts the support and results in downward displacement of the bladder, uterus and bowel towards the vagina.

Prolapse is more common in women aged over 55 years and multiple vaginal births.

About 1 in 8 women will develop a prolapse following a hysterectomy.

Other conditions such as obesity and chronic cough and constipation may increase the likelihood of developing a prolapse.

What are the types of prolapse?

• Cystocele – prolapse of the bladder into the vagina
• Rectocele- prolapse of the back passage (rectum) into the vagina
• Uterine prolapse-prolapse of the womb (uterus) into the vagina
• Enterocele-prolapse of bowel loops (intestine) into the upper vagina
• Vault prolapse- prolapse of the top end of the vagina (vault) after a hysterectomy into the vagina

Types of Prolapse

What are the symptoms of a prolapse?

• Feeling of a lump or swelling in the vagina
• Dragging or dropping sensation in the vagina
• Backache
• Frequency and or urgency to pass urine or feeling of incomplete emptying and/or incontinence
• Constipation or straining/digitating to open bowels
• Discomfort or painful intercourse

What treatment options are available?

Not everyone with a prolapse will need treatment, as many women will have a prolapse noticed at an examination or smear test and have no symptoms at all.

Pelvic floor exercises

Pelvic floor training programme taught by women’s health physiotherapist is helpful for the management of mild prolapse and urinary symptoms.

Pessary Management

A pessary is a small removable plastic device that is placed in the vagina to prevent the prolapse from dropping down. Ring and Gelhorn are the most commonly used pessaries, these help to relieve the symptoms but do not cure the prolapse.
Women have a reviewed every 4-6 months and this option is particularly useful for elderly patients or those keen to avoid surgery.

Surgical treatment

The type of surgery will depend on your symptoms and the type of prolapse seen on clinical assessment.

The aim of surgery is to replace the prolapse to its normal position and reinforce/support the weakened tissues – a repair operation.
It is sometimes necessary to perform a vaginal hysterectomy as part of the operation

Other more advanced procedures such as sacrocolpopexy and sacrospinous fixation may be necessary for women undergoing repeat surgery for prolapse.

Further details on the procedure to treat your prolapse will be discussed at your consultation.

For further information www.bsug.org.uk under guidelines and information.