Genital Prolapse

Many women may experience genital prolapse – i.e., an organ descends into the vagina. The most common form is a cystocele (bladder descent), but there are other types as we will see further on.

CAUSES

Pregnancy and childbirth seem to have a major impact. Other conditions can place you at risk of developing a prolapse, such as obesity, smoking, chronic cough, constipation and having undergone a hysterectomy. Action can be taken to compensate for these risks by losing weight, stopping smoking and eating more fibre.

CYSTOCELE

This is when the bladder slips down into the vagina and the vagina wall stretches to accommodate it. The main symptoms are a feeling of a mass or pressure in the vagina, vaginal irritation or the impression your bladder has not been completely emptied. A cystocele can be accompanied by urinary incontinence (involuntary leakage of urine). Incontinence and bladder descent do not always go together and are not treated in the same way.

With a mild to moderate cystocele, physiotherapy may reduce the size of the prolapse and make you feel more comfortable. There are also small prostheses (pessaries) which can be inserted into the vagina. These are generally in the form of a silicone ring; they are effective and well tolerated but, like any foreign body, they require special care. You can also have an operation. This generally involves short surgery via the vaginal route (via a natural pathway) followed by 4 to 8 weeks’ convalescence, during which you must avoid excessive effort, lifting weights and sexual activity. This type of surgery is generally effective, but there is always a risk of recurrence.

RECTOCELE

This is when the rectum bulges against the vaginal wall. Symptoms are a feeling of mass or pressure in the vagina, vaginal irritation, the impression your rectum has not been completely emptied, and constipation. Some women have to press their fingers against their vagina to make it easier to complete a bowel movement. For a mild to moderate rectocele, physiotherapy can reduce the size of the prolapse and make you more comfortable. Pessaries are also available in cases of a rectocele. Short surgery via the vaginal route is also possible, and you will then require 4 to 8 weeks’ convalescence. When dealing with a rectocele, it is important to change your lifestyle (eat more fibre and drink more liquids) in order to avoid constipation.

UTERINE PROLAPSE

This is when the uterus descends into the vagina. The main symptoms are a feeling of mass in the vagina and sometimes pain or heaviness in the lower back region. Uterine prolapse is often accompanied by another prolapse, such as a cystocele. Other than using a pessary, treatment is mainly surgical. A hysterectomy is often recommended, with resuspension of the vagina. The surgery is generally carried out using natural pathways. In some cases, an abdominal incision may be more appropriate. It is rare for the problem to be resolved without removal of the uterus, although some solutions are available to women who wish to keep their uterus

COLPOCELE

A colpocele occurs when the base of the vagina sags in women who have previously undergone a hysterectomy. The symptoms are like those of uterine prolapse. Other than using a pessary, the condition requires surgery either via the vagina or an abdominal incision. Your gynecologist will be able to explain the advantages and disadvantages of both techniques and recommend the one that seems best suited to your health and problem.

ENTEROCELE

This occurs when the small bowel bulges through the vagina. It is mainly found with a colpocele and is treated in the same way.

CONCLUSION

Although they can sometimes be very uncomfortable, prolapses are common after menopause and are generally not life-threatening. If you want to relieve your symptoms, you can discuss the available treatments with your gynecologist, ranging from physiotherapy to surgery. In the vast majority of cases, you will regain normal sexual function following surgery. Maintaining a healthy lifestyle can also be helpful.