Prolapse

Prolapse is very common, particularly after childbirth and around the menopause, and yet it is rarely talked about. Many women live with the sensation for years before mentioning it. There is a full range of treatments available, and surgery is only one of them.

What prolapse is

Prolapse happens when the tissues that support the pelvic organs weaken, allowing the walls of the vagina, the womb, the bladder or the bowel to descend from their usual position.

Common sensations include a feeling of something coming down, a dragging or heaviness, discomfort during sex, or difficulty emptying the bladder or bowel completely.

Why it happens

Several factors contribute, often in combination:

• Pregnancy and vaginal birth
• The reduction in oestrogen after the menopause
• Long-term coughing, constipation or heavy lifting
• Being overweight
• A natural family tendency towards weaker connective tissue

How it is assessed

Assessment involves an examination to determine which part of the vagina is affected and how far it has descended. It is also important to understand how much the prolapse is actually bothering you, because that — rather than the appearance alone — guides treatment.

Bladder or bowel symptoms are often part of the picture and are assessed alongside.

Treatment options

Treatment ranges from the conservative to the surgical, and mild prolapse that is not troubling you may need no treatment at all:

• Pelvic floor muscle training with a specialist physiotherapist
• Vaginal oestrogen to improve tissue quality
• A pessary — a device that supports the prolapse and can be very effective without surgery
• Surgical repair, which may be performed vaginally, laparoscopically or through an open approach
• Vaginal hysterectomy, where appropriate

A note on my practice

I perform prolapse surgery by vaginal, laparoscopic and open approaches. I do not perform surgery for urinary incontinence, and if that is your main problem I will make sure you are referred to a colleague who specialises in it.