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Prolapse

Pelvic organ prolapse occurs when laxity of the ligaments and muscles that surround the vagina cause the neighbouring organs to fall into the vaginal canal. It presents with a feeling of pressure in the vagina, like the presence of a ball of tissue coming through the vaginal opening, or the sensation that a tampon is stuck in the vagina. It can be alarming for a woman to experience pelvic organ prolapse, but it is not dangerous. It is correctable with safe and effective treatments. Approximately fifty percent of women who have experienced childbirth have varying degrees of pelvic organ prolapse. 

Four organs can collapse into the vaginal canal. They include the bladder (anterior vaginal wall prolapse or a cystocele), the uterus (apical or uterine prolapse), the rectum (posterior vaginal wall prolapse or a rectocele), and the small intestine (enterocele). It is difficult, or nearly impossible, for a woman to know which organ or organs have fallen. An experienced doctor will be able to tell upon examination.

Treatments include pelvic organ muscle exercises, (which can be performed with the guidance of a pelvic floor Physio), the use of a pessary (a silicone disc that is inserted into the vagina and can be fitted by our physio’s or our Doctors), or surgery.

If you think that you have a pelvic organ prolapse, and you want to know your options for treatment, please come and visit us

Surgery for Pelvic organ prolapse

If you have a uterus or bladder that is prolapsing, you will need to make a decision together with your gynaecologist if you want surgery that uses stitches to lift and keep your prolapsed womb in place (called hysteropexy) Or if you want to have your uterus and cervix removed (Hysterectomy). If your uterus is removed you still need to hitch up the top of the vagina (vault) with stiches to pelvic ligaments. 

Some studies suggest that women who have a hysteropexy are less likely to have recurrent symptoms than those who have their womb removed (vaginal hysterectomy). There is also a shorter operating time, less chance of blood loss and less pain with a Hysteropexy. 

While vaginal hysterectomy is still widely seen as the first treatment choice for women with uterine (womb) prolapse, the use of surgery which preserves the uterus by using stitches to support the pelvic organs is becoming more common.

If you don’t have a uterus and the top of the vagina or bladder is prolapsing you have the option of a vaginal repair with dissolvable stiches or to use mesh via key hole surgery to hold the bladder and the vagina in place. The mesh procedure is more effective than a vaginal repair in the long term. 

Regardless how you decide to suspend the womb or the vault (top of vagina) you will most likely also have a posterior repair that reinforces the pelvic floor muscles and the perineum (area between the vaginal and the back passage. You may also have a repair under the bladder called an anterior repair.