A B C D E F G H I J K L M N O P R S T U V W

VAGINAL PROLAPSE

What is vaginal prolapse ?

The womb is at the top of the vagina. The bladder is in front of the vagina with the rectum behind. Any or all of these organs can prolapse (or drop down), all or part of the way down the vagina. Most women describe a feeling of something coming down . This is worse at the end of the day and in women leading a physically strenuous life. A lump may be noticed at the opening of the vagina. If the bladder is involved, bladder infections are possible. A woman may wet herself a little when coughing or straining. Some women have difficulty in starting to pass urine or opening their bowel. They may have to push the prolapse back to overcome this problem. A prolapse may cause low back ache, and difficulties with intercourse.

How does vaginal prolapse occur ?

The main support of the womb, bladder and bowel is the pelvic muscular diaphragm. This is weakened by childbirth, especially difficult births. It also gets weaker after the menopause and in women who are constantly straining. Such strain can be due to chronic coughs, chronic constipation and heavy physical work. Obesity may also strain the pelvic diaphragm.

Why does vaginal prolapse occur ?

Prolapse will be commonest in women who have had several, or difficult births. The likelihood of developing it increases with age, especially after the menopause. Women who smoke are prone to chronic bronchitis and hence prolapse.

Treatment involved in vaginal prolapse

If urinary incontinence is a problem, special tests may be done. Otherwise the diagnosis is clear from the examination. If a prolapse is not causing any symptoms is does not need to be treated. HORMONES Prevention is of course the best treatment of all. It is possible that hormone replacement therapy may help to keep the tissues stronger. Hormone creams applied to the vagina will never cure prolapse but may help some symptoms. EXERCISES A physiotherapist may be able to help by giving exercises to strengthen the pelvic diaphragm. These are simple to do. The principle is to imagine one is passing urine, and stop half way through. PESSARIES The gynaecologist can fit a pessary. This is a flexible plastic ring which comes in different sizes. It can be simply fitted into the vagina. It supports the prolapse but needs changing every 3 to 6 months. It may chafe the skin and cause some bleeding or discharge. It is used only in those who are unfit for, or do not want, surgery. SURGERY The operation for prolapse is called a vaginal repair. It involves repairing the weakness in the tissues and tightening up the vagina. The operation is done through the vagina. It is like making a pleat in the front and back walls of the vagina. Often a hysterectomy is done at the same time.

During treatment of vaginal prolapse

If using a pessary, any bleeding should be reported. It is important to change the pessary regularly. This may be done at the hospital or the GP's surgery. Non-surgical treatment will never cure a prolapse. However, it may stop it getting worse and may help the symptoms. Before any operation, the surgeon will need to know whether the woman wishes to continue having intercourse. The best results are obtained if the vagina is stitched up quite tightly: this could make intercourse difficult or impossible. You will need to stay in hospital for about 4 to 5 days, with at least 6 weeks convalescence.

After Treatment of vaginal prolapse

Unfortunately prolapse can recur. This is because it is due to a weakening in the tissues that cannot be reversed. However skilful the surgeon may be, the repaired tissue may give way again. One can reduce the risk of this by giving up smoking and not allowing oneself to become overweight. Lifelong, one must guard against sudden, strenuous lifting or exertion. The scar tissue in the vagina may shrink in time. This may make intercourse difficult afterwards.

If vaginal prolapse is left untreated

Prolapse will usually get slowly worse with increasing age. In extreme cases the womb may finish up completely outside, rubbing on the underclothes (procidentia). This can cause the skin of the vagina covering the womb to become infected or bleed. Very rarely it may kink the tube between the kidneys and the bladder (the ureters) and cause kidney failure. In most cases a woman will not suffer any long term damage to her health if prolapse is not treated. If prolapse is small and not causing any symptoms treatment can safely be left until symptoms are a problem. Prolapse is treated to make the woman more comfortable and to help urinary or bowel symptoms.

Effects on family of vaginal prolapse 

It is important that the family understands the nature of your operation. Somebody must do the heavy carrying. They must understand the need to be careful about picking up grandchildren. Husband and wife should talk about their feelings in relation to intercourse with the surgeon both before an operation, and at the 6 week follow-up.