Prolapse

What is prolapse?
Prolapse occurs when weakened pelvic muscles and ligaments allow the uterus and cervix to slip into the vagina and can sometimes protrude from it. It is a common problem with many women but one that is rarely discussed due to embarrassment.

Prolapse does not discriminate in relation to age. It can happen to women at any point of their lives, from young to older. It is uncomfortable, distressing and needs to be remedied as neglecting a protruding prolapse can lead to chaffing and infection. Prolapse affects a woman’s sex life due to embarrassment and pain.

Childbirth is the single biggest risk factor in developing uterine prolapse although women who have not given birth can also experience prolapse. If pushing during labour was prolonged, the baby large, a tear occurred or forceps were used, then the risk is increased.

Weakening of muscles with age and the decrease in oestrogen after menopause weakens the surrounding tissues of the uterus further, thus leading to prolapse. Prolonged heavy lifting, strenuous coughing or constipation are also causes.

Prolapse

Prevention
You may not be able to avoid prolapse but here are some hints that may help:

  • Continuously practice pelvic floor exercises
  • Keep your weight within a normal range
  • Avoid heavy lifting
  • Have a healthy diet to avoid constipation and straining

Treatments
If you have mild symptoms, avoid anything that worsens the condition. Your gynaecologist may recommend the insertion of a vaginal ring pessary which is positioned to prop up the cervix and uterus. This works for those wishing to have more children or do not wish to have an operation.

For those with severe symptoms, surgery may be recommended. If you have completed your family, removal of the uterus is recommended together with an anterior and posterior vaginal repair and sacrospinous colpopexy (hitching up the vagina).

For those with severe prolapse who want to preserve their fertility, the vaginal repair is done together with a hysteropexy (hitching up the cervix). There is a small risk of recurrence of prolapse after surgery with about 10% needing redo surgery.