Prolapse
What is it?
Prolapse is a common gynaecological condition. The presence of prolapse is related
to the muscles surrounding the vagina and the supporting structures for the pelvic
organs (the bladder, uterus or womb, and the bowels). Normally, the pelvic organs
are held up by a collection of interrelated muscles, strong fibrous tissue and ligaments,
rather like a strong hammock. These supporting muscles and ligaments may weaken with
time, pregnancy and childbirth, chronic straining and heavy lifting, and result in
prolapse. Again, rather like someone heavy suddenly sitting in a soft hammock, the
pelvic organs may begin to sink into the weakened vaginal muscles, and cause a bulge
or lump in the vagina which is often felt as something bearing down, or may even
be a visible lump.
What are the treatments?
It is important to remember that many women will have a certain degree of prolapse,
and the decision for treatment is very much dependent on the impact that your symptoms
have on your quality of life. There are a range of non-surgical and surgical treatments,
and the choice will depend on your wishes, and your medical and surgical history.
If you have associated problems with your bowel and/or bladder you may require additional
specialist tests (pelvic ultrasound, MRI, or urodynamics).
Non-surgical treatments:
This involves pelvic floor muscle training and vaginal support pessaries. We have
a team of specialist nurses and physiotherapists who can help you with these therapies.
Surgical Procedures:
There are many surgical procedures that may be suggested as treatments for prolapse
(see information sheets on individual operations). Operations may be done via the
vagina or abdomen (through small holes “laparoscopy” or as a bigger cut “open” procedures).
This will mostly be determined by the extent of your prolapse and the symptoms you
have.
In women with uterine prolapse, who wish to retain their uterus we would recommend
a laparoscopic hysteropexy. Should hysterectomy be indicated then this may be done
laparoscopically or vaginally. Some women have significant areas of prolapse in other
parts of the vagina that may require a vaginal repair. This is either performed as
a separate procedure or is combined with treatment for uterine prolapse depending
on the nature of the prolapse.
In women who have prolapse following a hysterectomy where the top of the vagina is
coming down we normally recommend a laparoscopic sacrocolpopexy.
