Prolapse is a very common condition in gynaecology. Symptoms include a dragging / bulging sensation or difficulty with sexual intercourse, passing urine, opening your bowels or inserting tampons. In addition some ladies may be aware of a low back ache.
The biggest risk factor for prolapse is previous pregnancy, especially long labours, instrumental deliveries and big babies. Other things that increase the risk are being post menopausal, being over weight and smoking.
Generally gynaecological prolapse is divided into uterine prolapse, where the womb is dropping, anterior compartment prolapse, where the bladder and urethra are prolapsing (also called a cystocele/ cystourethrocele) or posterior compartment prolaspe, where the bowel is prolapsing towards the vagina (also known as a rectocele or enterocele)
Treatment can be surgical or non surgical. Whilst physiotherapy is very effective at treating urinary stress incontinence and reducing chances of new or recurrent prolapse, once a significant prolapse has occurred it is of limited benefit. Thus the treatment comes down to the use of vaginal pessaries or surgery. Pessaries are plastic devices that are inserted into the vagina and ‘hold things up’. They can be fitted in clinic and once the correct size is established generally need removing and replacing once or twice a year. The use of such devices carries very little risk, but they can cause problems with intercourse and sometimes cause ulceration of the skin of the vagina where they rub. The other treatment is surgical using combinations of vaginal hysterectomy, anterior and posterior repair , depending on what has prolapsed.