Andrea Tyas 2015 Review 2107

Department of Gynaecology

Vaginal Prolapse

What is a prolapse?

A prolapse is a weakness of the supporting structures that hold an organ in place. In women vaginal prolapse is common and can cause the bladder, womb or rectum to bulge into the vagina often creating a lump that can be felt.

Causes: The most common causes of a prolapse are:

Damage to the pelvic floor muscles during childbirth. This risk is increased with multiple births.

Menopause due to lack of oestrogen

Heavy lifting

Chronic cough

Being overweight

Previous abdominal surgery

Symptoms:

Some women may experience very little problems and may not be aware of any prolapse until being examined by the doctor. The most common symptoms are a feeling of “something coming down” a fullness or dragging sensation in the vagina. Other symptoms include urinary problems such as frequency, urgency, leakage on coughing, sneezing or exercise (stress incontinence). Women with a bowel prolapse into the vaginal may suffer with constipation and difficulty emptying the bowel.

Types of Prolapse

  • Cystocele -This is a prolapse of the bladder into the front vaginal wall.
  • Rectocele - This is a prolapse of the rectum into the back vaginal wall.
  • Enterocele - This is a prolapse of the small bowel into the vagina.
  • Uterine prolapse. - This is a prolapse of the womb into your vagina. There are different degrees of this prolapse and these are graded.
  • Procidentia. - A complete womb prolapse. This is where the womb hangs outside of the vagina.

Conservative Treatment

If you do not have any symptoms then no treatment will be required. Mild prolapse symptoms may only be monitored and referral for pelvic floor exercises may help reduce the prolapse.

The fitting of a pessary into the vagina to support the prolapse may be the treatment of choice. This tends to be used for women who are medically of surgically unfit for surgery. It can also be used as a preference to surgery in patients who are not sexually active. A patient information leaflet is available for vaginal ring pessaries explaining all its risk and benefits

Surgical Treatment.

If you have been advised that surgery is the best method of treatment for you then a number of operations that are available depending on the type of prolapse you have. These include:

  • Anterior repair -Repair of front vaginal wall.
  • Posterior repair -Repair of the back vaginal wall
  • Repair of entrocele -Repair of top of vaginal wall.
  • Vaginal hysterectomy -Removal of the womb through the vagina.
  • Vaginal sacrocolpopexy/ abdominal sacrospinous fixation -A sling type of operation, which reduces the prolapse by attaching the vagina to your backbone/backbone ligament.

Your doctor will discuss the type of prolapse you have and the best method of treatment that will benefit you. This information sheet gives you a brief insight into the different types and causes of a prolapse. There are additional information leaflets on all the surgical treatments detailed above, explaining all the risks and benefits. If you require any further information please do not hesitate to contact us.

Gynaecology Outpatients dept 01226 432217

Urogynaecology dept 01226 434949

Ward 14 01226 432261