Prolapse and Incontinence
Pelvic organ prolapse occurs when the muscles that hold the internal pelvic organs in their correct position become weakened. This allows organs to drop or prolapse into the vagina. It could be the uterus, bowel or bladder.
- Sensation of heaviness or pulling in your pelvis which is worse when coughing or sneezing, or after standing for a long duration of time.
- Tissue protruding from your vagina.
- Urinary problems, such as urine leakage or urine retention.
- Trouble having a bowel movement- such as incomplete evacuation and constipation
- Low back pain.
- Feeling as if you’re sitting on a small ball or as if something is falling out of your vagina.
- Sexual concerns, such as sensing looseness in the tone of your vaginal tissue.
- Symptoms that are less bothersome in the morning and worsen as the day goes on.
Aims of treatment for utero-vaginal prolapse
- Reduce pain.
- Restore normal bladder and bowel functioning.
- To have comfortable sex.
- Decrease the risk of urinary infections and ulceration of the prolapsed organs.
What causes utero-vaginal prolapse
- Pregnancy and childbirth are considered to be the main causes. A prolapse may occur during or shortly after the pregnancy or may take years to develop.
- Age and menopause are further factors for weakening of the pelvic support structures.
- Obesity, chronic cough, chronic constipation, heavy lifting and smoking
- Inherited weakness of connective tissues such as Marfan’s syndrome and joint hyper-mobility
Are there any complications of utero-vaginal prolapse?
If the prolapse causes the cervix (neck of the womb) or the skin that lines the vagina to protrude from the vagina, this can lead to ulceration, bleeding and infection. If the prolapse affects the bladder or the urethra, complications may occur such as urinary tract infections (UTI), urinary incontinence (loss of bladder control) and urinary retention (an acute inability to pass urine which may require treatment with a catheter). If the prolapse affects the rectum, there can be difficulty passing stool and incontinence of stool.
Treatment options for utero-vaginal prolapse
- Removal of any exacerbating factors
- Pelvic floor exercises
- Vaginal pessaries
- Vaginal oestrogen creams
- Laparoscopic surgery or vaginal surgery with or without mesh
Pelvic floor exercises are essential for all women with or without prolapse. It is recommended before and after surgery to improve the outcome of surgical and conservative management.
How can I prevent utero-vaginal prolapse?
- Do regular pelvic floor exercises with a physiotherapist
- Avoid soap in genitalia
- Use oestrogen cream if post-menopausal
- Prevent constipation (eat a high fibre diet)
- Stop smoking
- Lose weight if necessary
- Do weight lifting at the gym in lying or semi- sitting position
- Avoid any exercises that increase the abdominal pressure such as full sit-ups and crunches
- Carry your grocery shopping one bag at a time and do not overload it!
- If any respiratory problems, like asthma, seek help