What is a prolapse?

Spire Methley Park Hospital's Consultant Gynaecologist Mr Farag answers some commonly asked questions about prolapse.

What is prolapse?

Prolapse (from Latin prolapsus, a slipping forth) refers to the falling or slipping out of place of a part or viscus.

Prolapse is a hernia of the vagina that women feel as bulge or pressure. This is referred to in many different ways; sometimes it is called ‘dropped vagina’, ‘dropped bladder’, ‘dropped womb’ or ‘dropped rectum’. Your doctor may have also called this a cystocele or rectocele.

The pelvic floor muscles are a group of muscles at the base of your pelvis that support the vagina, womb, bladder and bowel. When the pelvic floor muscles weaken or stretch, a prolapse can occur. This is where one or more of the organs within your pelvis lacks support and drops of fall down.

Types of prolapse

• Cystocele: anterior/front/ bladder prolapse
• Rectocele: posterior/back/bowel prolapse
• Uterine prolapse: prolapse of the womb
• Vault prolapse: prolapse of the top of the vagina after hysterectomy

A woman may have more than one of these type prolapse.

Symptoms of prolapse

Your symptoms depend upon what type of prolapse you have.

Symptoms can include:

• Aware of a ‘bulge’ or ‘something coming down’
• Feeling of fullness or heaviness in the pelvic organ
• Pulling or aching feeling in the lower abdomen or pelvis
• Painful or uncomfortable sex
• Difficulty urination or defecation

When should I consider surgery to treat pelvic organ prolapse?

If your symptoms are severe and disrupt your life, and if non-surgical treatment options have not helped you may want to consider surgery.

What factors should I consider when deciding whether to have surgery?

• Your age. If you have surgery at a young age, there is a chance that prolapse will recur and possibly require additional treatment.
• Your childbearing plan. Women who plan to have children or more children should postpone surgery until their families are complete to avoid the risk of prolapse happening again.

What are the types of surgery for pelvic organ prolapse?

In general the majority of prolapse surgeries are performed via the vagina. This means that there are no surgical incisions (cuts) made on the abdomen (tummy).

Usually the surgeries are reconstructive. This means surgery reconstructs the pelvic floor with the goal of restoring the organs to their original position. There are different types of reconstructive surgery depending on the type of prolapse.

Do I have to have a hysterectomy as a part of my surgery?

No, only if the there is a significant womb prolapse. Whether or not to remove the uterus should be discussed between the patient and her surgeon, and the decision should be individualised from patient to patient.

What is involved in recovery after surgery?

Some vaginal bleeding may occur during the first week or so. Your vaginal loss should change to a creamy discharge over the next 2-3 weeks – this is quite normal. Do not use tampons.

Recovery timeline

• Do not drive an automatic car for 1 week
• Do not drive a manual car for 2 weeks
• Do not make a bed for 2 weeks
• Do not take a bath but instead take a shower 2 weeks
• Do not squat to do the washing or hang it out for 4 weeks
• Do not use your vaginal oestrogen for 4 weeks
• Do not stretch upward for 6 weeks
• Do not do any lifting for 6 weeks
• Do not have sexual intercourse for 6 weeks

Remember to rest. If you are tired and uncomfortable you have been doing too much and need to slow down.

Swimming is an excellent way to keep you active and this may be resumed after 2 weeks.

When emptying your bladder, sit on the toilet, feet flat and lean forwards. Please ensure that you empty your bladder every three hours during the daytime.

Drink 6 to 8 glasses of fluid per day; limit your caffeinated drinks to 3 per day. Ensure your fibre intake is 30g per day. If constipation is a problem, Lactulose or another stool softener should be used, which you can buy from the chemist.

Patients who follow the recommended restrictions after surgery give themselves the best chance for permanent success.

How successful is surgery for pelvic organ prolapse?

The aim of pelvic reconstructive surgery is to recreate normal anatomy permanently. However none of these procedures are successful 100%. According to the medical literature, failures occur in 5-15% of women who have prolapse surgery.

Many factors affect the outcome of reconstructive surgery. Some of the factors that originally contributed to your pelvic floor problems, such as decrease muscle and nerve function and week connective tissue, might still exist after the reconstructive procedure has been performed.

To increase the success rates simple measures to be followed are:

• Weight loss if overweight
• Reducing or quitting smoking
• Treating conditions that might put strain on the pelvic floor, such as a chronic cough or constipation
• Improving pelvic muscle tone by doing pelvic muscle exercises and continuing to do them after surgery. Please ask for a leaflet explaining how to do pelvic floor exercises at your follow up appointment

Is there a place for surgery if I have recurrent prolapse post-surgery?

Yes, there is a place for surgery. However you should be seen and assessed by a gynecologist specialized in this area.

If you would like more information, make an enquiry.