What is pelvic prolapse?
Pelvic prolapse is when 1 or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. It can be the uterus (womb), bowel , bladder or top of the vagina. A prolapse is not life threatening but may cause pain and discomfort. Symptoms can usually be improved with pelvic floor excercises (PFE) and life style changes but sometimes medical treatment is needed.
What are the symptoms?
Loss of bladder (see urinary incontinence) or possibly bowel control.
Difficulty voiding.
Urinary frequency.
Problems with bowel movements.
Feelings of pelvic or vaginal heaviness, bulging, fullness and/or pain.
Recurrent bladder infections.
Discomfort or lack of sensation with intercourse.
How common is pelvic prolapse?
It is a very common disorder particularly in older women. Half of all women over the age of 50, experience some degree of pelvic prolapse.
Causal factors
Congenital weakness of the pelvic ligaments.
Multiple vaginal deliveries. This is more likely if labour has been prolonged.
Oestrogen deficiency i.e. menopause.
Obesity.
Chronic cough.
Constipation.
Previous pelvic surgery.
Types of pelvic prolapse
Cystocele A cystocele, or anterior wall prolapse occurs when the bladder drops from its normal position into the vagina. This can lead to dragging discomfort, the sensation of a lump in the vagina and occasionally urinary symptoms. It can also cause discomfort during intercourse.
Rectocele A rectocele, or posterior wall prolaps occurs when the rectum protrudes into the or out of the vagina. It may cause problems with bowel movements or the feeling of incomplete bowel emptying.
Vaginal Vault A vaginal vault prolapse occurs when the tissue which attaches the top of the vagina to the pelvic sidewall, becomes torn. This causes the top of the vagina to drop, which in turn causes the front and the back of the vagina to drop.
Uterine A uterine prolapse occurs when the uterus drops either by itself or as a result of the prolapse from a different part of the vagina. This may cause lower back pain. A patient with total uterine prolapse may complain protrusion of the cervix and a blood-stained discharge.
Treatment
Losing weight, pelvic floor exercises and hormone replacement therapy given at the time of the menopause may help prevent development of postmenopausal prolapse but is unlikely to alter established prolapse.
Mr Pakarian works in collaboration with physiotherapists and often refers patients to the physio prior to surgery (if indicated).
Pessary
This is can be used if the patient wants to avoid surgery or medically unfit for surgery, for relief of symptoms whilst awaiting surgery or as a therapeutic test to confirm that surgery could help.
Surgical
Main treatment of prolapse is surgery.
On average Mr Pakarian carries out between 3-5 prolapse and incontinence surgeries in a week. All patients are discussed at MDTs prior to surgery.