In women, the pelvic organs—bladder in the front, uterus or womb in the middle, and bowel at the back—are supported by muscles, tissues, and ligaments in the pelvis, forming the pelvic floor support. When the supportive structures in the pelvic region weaken, a prolapse happens because they can no longer keep the pelvic organs in place.
Uro-genital prolapse is the symptomatic descent of one or more of the following:
● The front (bladder) vaginal wall.
● The back (bowel) vaginal wall.
● The apex (top) of the vagina (cervix/uterus) or vault (cuff) post hysterectomy.
Prolapse can manifest in various degrees:
● First-degree prolapse: Uterus partially descends into the vagina.
● Second-degree prolapse: Uterus reaches the vaginal opening.
● Third-degree prolapse: The uterus partially protrudes outside the vagina.
● Complete Procidentia: The entire uterus descends below or outside the vagina.
When the pelvic floor support weakens, it leads to the symptomatic descent of the pelvic organs. This descent varies in degrees, ranging from partial descent into the vagina to the complete protrusion of the uterus outside the vaginal opening.
These degrees of prolapse highlight the severity of the condition, with first-degree prolapse indicating a partial descent of the uterus, second-degree prolapse involving the uterus reaching the vaginal opening, and third-degree prolapse involving partial protrusion of the uterus outside the vagina. The most severe form, Complete Procidentia, occurs when the entire uterus descends below or outside the vaginal opening.
Vaginal Prolapse Treatment
Several treatment options exist for treating pelvic organ prolapse in women, and not all necessitate surgery. The approach to pelvic organ prolapse treatment should focus on alleviating symptoms while considering factors like the woman’s sexual activity and future childbearing plans.
Vaginal prolapse treatment encompasses conservative approaches, vaginal pessaries, and surgical procedures.
Conservative treatments, such as lifestyle adjustments, are often effective, especially when the prolapse is not severely impacting daily activities. In many cases, the issue resolves on its own without extensive intervention.
For those requiring treatment, adopting simple lifestyle changes can be beneficial. Natural remedies involve avoiding activities that strain the pelvic region, like heavy lifting. Top Gynaecologists recommend continuing pelvic floor exercises, known as Kegels, and maintaining a healthy weight.
You must address constipation by following a high-fibre diet to prevent additional strain during bowel movements. If you smoke, quitting is advisable, as coughing can aggravate prolapse symptoms.
If these conservative measures prove insufficient, consider a Private Gynaecologist in London who may recommend a pelvic floor muscle strengthening programme. It is particularly essential for preventing prolapse recurrence post-surgery or the emergence of a new prolapse in areas not previously affected.
Pelvic Floor Exercises for Vaginal Prolapse Treatment
Engaging in pelvic floor exercises is beneficial for enhancing the strength of your pelvic muscles. These exercises support your bladder and the tightening around the bladder neck and urethra during increased abdominal pressure, such as bending or running. Physiotherapists can teach specific exercises designed to fortify these muscles. To boost the effectiveness of these exercises, you can also incorporate vaginal cones (weights), biofeedback monitors, or electrical stimulation. Practising pelvic floor exercises regularly at home is crucial for achieving optimal results. It’s noteworthy that these exercises have the potential to improve stress incontinence in up to 70% of women, but consistency is crucial to their success.
Grade 1 prolapse causes no pain or discomfort. So, medical or surgical intervention is typically unnecessary. However, seeking advice from a consultant by scheduling an appointment can provide you with more detailed information about pelvic floor exercises.
Vaginal Prolapse Treatment with Pessaries
Many women wonder about non-surgical solutions for prolapse management. If conservative methods prove ineffective in relieving prolapse symptoms, a vaginal device becomes an option.
One commonly used device is the ring pessary, which is a removable tool inserted into the vagina to support and maintain the position of prolapsed organs.
Ring pessaries are popular because they don’t obstruct the vagina, allowing for sexual intercourse. While requiring replacement every six months, they generally go unnoticed and don’t interfere with any desired activities.
There are alternative devices like the shelf, Gellhorn, and cube pessaries, which may not be suitable for sexual activity due to blocking the vagina. However, the cube pessary stands out as it allows self-insertion and removal by the patient, facilitating use before and after intercourse.
Vaginal pessary devices offer advantages over surgery, as they entail lower risks and can be inserted or replaced in an outpatient setting without the need for anaesthesia.
Despite these benefits, there are drawbacks to consider. Pessary devices may fail, leading to issues such as displacement, where the prolapse may cause the ring to move from the vagina despite adjustments in size or device type. This treatment requires ongoing appointments, which may be impractical for some women. Additionally, vaginal pessary devices can result in a vaginal discharge.
Vaginal Prolapse Treatment Options
You can treat pelvic organ prolapse through various surgical procedures, broadly categorised into vaginal and abdominal approaches. Vaginal procedures aim to tighten the tissues from below, addressing mild to moderate vaginal prolapse. On the other hand, for more severe cases, abdominal procedures are suggested. These involve lifting and securing pelvic organs, using either mesh or non-mesh suture techniques to support the vaginal vault.
Abdominal Surgery
In non-mesh sacrocolpopexy, a strip of the abdominal wall replaces mesh to attach the top of the vagina or uterus to ligaments on the front of the sacrum (tailbone). It provides an alternative to synthetic mesh, avoiding potential complications associated with mesh usage.
Mesh sacrocolpopexy involves implanting abdominal mesh to attach the top of the vagina or uterus to the sacral ligaments. This option is considered for women with severe or recurrent prolapse, offering robust long-term support, albeit with potential mesh-related risks.
Gynaecologists recommend a hysterectomy in cases where removing the uterus is necessary for other reasons. Depending on the specific prolapse situation, the procedure can be conducted through the vagina, robotically, laparoscopically, or abdominally. Simultaneously, specialists perform additional procedures to prevent prolapse.
Vaginal Surgery
Anterior colporrhaphy, also known as cystocoele repair, involves stitching to rebuild support for the anterior vaginal wall under the bladder. It corrects herniation or weakening of the front wall, improving bladder emptying. The stitches dissolve after six weeks, relying on tightened tissue for ongoing support.
Posterior colporrhaphy, or rectocoele repair, uses stitches to support the posterior vaginal wall between the vagina and lower colon/rectum. Strengthening the weakened back wall may alleviate bowel evacuation issues, pelvic pressure, or low back pain. Dissolvable stitches are used, with reliance on tissue tightening for lasting support.
Enterocoele repair addresses weaknesses allowing the small bowel to descend through the vagina, using dissolving stitches to close off the affected area.
Sacrospinous fixation, a vaginal operation, supports the top of the vagina to deep pelvic ligaments using permanent stitches, enhancing overall structural stability.
Pelvic Floor Surgery
If persistent pain and discomfort arise from pelvic organ prolapse and lifestyle changes or pessaries fail to provide relief, surgery emerges as a viable option. Nearly 1 in 10 women opt for surgery by the age of 80 when faced with this condition.
Various surgical choices cater to women experiencing symptoms of vaginal prolapse, determined by factors like organ involvement, prolapse severity, and concurrent medical conditions. These options encompass vaginal repair, vaginal hysterectomy, uterus-preserving prolapse surgery, and vaginal and perineal reconstruction.
The London-based private gynaecologists’ clinic predominantly performs minimally invasive procedures for prolapse through the vaginal route. This approach ensures no abdominal cuts or stitches, resulting in quicker recovery and shorter hospital stays. Additionally, their advanced laparoscopic surgeon extends a range of laparoscopic procedures.
The collaborative nature of Top Gynaecologists facilitates a comprehensive gynaecological service. Consultants often collaborate in managing women with other closely linked gynaecological conditions, such as period problems or endometriosis, alongside prolapse or pelvic floor issues.
