Vaginal prolapse (or pelvic organ prolapse) affects 40% of adult women. It involves the pushing of nearby structures (bladder, uterus and rectum) down into the vagina, often producing a sensation of fullness or “something coming down”. Women may see or feel an unusual bulge vaginally. For other women, prolapse can cause urinary incontinence or discomfort during sexual intercourse. However, many women with prolapse have no symptoms at all and can live happily with the condition.
My mother had a prolapse and now my GP thinks I do too – what causes prolapse?
There is no single cause for prolapse – several different factors contribute to a woman’s risk. The leading cause by far is pregnancy and vaginal childbirth. However, it is not the only cause. Older age and a higher body weight are also established risk factors. Finally, conditions associated with increased abdominal pressure (constipation, chronic cough, heavy lifting) increase the risk.
I want to do something about this prolapse – what treatment can you offer me?
Although prolapse is very common, many women will have no symptoms from their prolapse. Treatment is only needed for women who have symptoms from their prolapse. For those women who are severely affected by prolapse symptoms, several treatments are available. The team at SHORE FOR WOMEN have considerable experience in caring for women affected by prolapse. Dr Colin Walsh has cared for hundreds of women with vaginal prolapse; indeed he wrote the chapter on vaginal prolapse in a major international gynaecological textbook.
Prolapse is classified according to the structures involved. In general, there are 3 types of prolapse:
Women who have had a hysterectomy can still have prolapse of the top part of the vagina (called vault prolapse). Most women have some degree of prolapse in all 3 areas, although 1 component may be more troublesome than the others.
It is also important to realise that there are different degrees of severity of prolapse. This helps determine what the best treatment is. Many women who have given birth vaginally will have a mild degree of vaginal prolapse – it does not mean surgery is necessary.
The main treatment for women with bothersome vaginal prolapse is surgery. Several different surgeries are available, depending on the prolapse severity and which structures are prolapsing. Every woman is different and the exact prolapse surgery should be individualised for each patient.
Most commonly, the prolapse involves the uterus and cervix and these must be removed by a vaginal hysterectomy. Hysterectomy corrects prolapse of the uterus and cervix but does not treat prolapse at the front or back of the vagina. If these are also troublesome, a vaginal reconstruction (repair) may also be required. Vaginal hysterectomy and vaginal repair are different surgeries but are often combined into a single operation.
I want prolapse surgery but I also want my ovaries removed – is this possible?
Yes. Your prolapse surgery will be completed vaginally as with any vaginal reconstruction. In addition, a small camera is inserted into the woman’s belly-button and both ovaries and tubes are removed via keyhole surgery. This additional surgery adds about 30 minutes to the overall operation.
My friend was told that surgery using mesh is better for prolapse – can you explain?
No surgery for prolapse lasts forever. All prolapse surgeries are associated with recurrence rates of 20-30%. Vaginal mesh repair uses a sheet of plastic mesh to reinforce the vaginal walls. Although recurrence rates are lower after mesh repair, 10% of women have serious problems with mesh “exposure” (or rejection). Dr. Colin Walsh has successfully treated many women with vaginal mesh and can advise you of the risks and benefits for your particular situation.
I have vaginal prolapse and urinary incontinence – can you fix both problems?
The bladder lies very close to the vagina and many women are affected by both prolapse and urinary incontinence. Depending on the type of incontinence, it may be possible to perform operations for both the prolapse and incontinence at the same time. This is a complex area and one which is best discussed with an experienced gynaecological surgeon. The team at SHORE FOR WOMEN have cared for many women with both prolapse and incontinence.
My prolapse is a bit bothersome but I do not like the idea of major surgery?
Many women with milder forms of prolapse do not wish to undergo major vaginal surgery but simply want to reduce the chances of the prolapse getting worse over time. Lifestyle advice and avoiding constipation and chronic straining is helpful for these women. We also know that a regimen of regular pelvic floor exercises can improve mild prolapse symptoms and stop prolapse from getting worse. Ideally, this should be with the help of an experienced pelvic floor physiotherapist – Dr. Walsh can help you locate an experienced physiotherapist near you.
The other helpful treatment option for women with prolapse who do not wish to have an operation is the use of a silicone vaginal support pessary. Vaginal pessaries are available in several different sizes and a suitable size can be found for most women.