10 Sep What is Prolapse
Causes and potential remedies
On a daily basis we get asked by women ‘what is prolapse’? So we asked our clinical advisor Dr Maire Milner obstetrician and gynecologist for over 35 years to tell us about this pelvic challenge.
Women are vulnerable to hernia or prolapse of our pelvic organs mainly because of the design of our bodies. The entrance- the vagina- has the bladder on the front wall and the bowel on the back, and this is the passage where lovemaking occurs and through which the baby descends in childbirth. These organs lie on and pass through a thin sheet of muscle underneath called the ‘pelvic floor’, which is attached to the bones of the pelvis both at the front- the pubic bone- and at the back- the sacrum. The pelvic floor can be damaged, stretched, or torn during delivery, and this is the main reason why our pelvic organs tend to drop down or prolapse in later life: one or more of the womb, bowel and bladder- or even the whole vagina after a hysterectomy has been carried out: this is called an enterocoele. This is also why women develop stress incontinence- leaking urine on coughing or sneezing- as the pelvic floor holding the passage from the bladder has sagged due to damage during delivery, no longer keeping you dry. However in this blog we will deal with prolapse only to keep things simple.
Probably 50% of all women(who have given birth) have some degree of prolapse.
This is not to say that women who have only had caesarean sections, or indeed never had a baby, cannot develop prolapse and urine leakage: they can & they do, but it is far less common.It is important early on in our blog to say that many women- probably about half- have some degree of ‘prolapse’ to be seen when they have a pelvic examination. This is in part because of the position we are usually examined in: as we are lying down the prolapse tends to go back, on the other hand the legs being apart opens the vagina to a degree that doesn’t happen on standing. The vast majority of women however do not have any troubling symptoms, or perhaps a slight awareness that does not bother them. There is absolutely nothing to be done about a ‘prolapse’ unless it is bothering you. The ‘looseness’ of the vaginal muscles and walls is a direct consequence of childbirth.
What is Cystocele and Rectocele
Prolapse of the front wall is common & called a Cystocoele, prolapse of the back wall is also common & called a Rectocoele. Common complaints with a prolapse would be a feeling of a bulge/ pressure /dragging /something coming down. These will be more prominent at the end of the day because of the hours of downward pressure, which is relieved when you lie down. Backache and tummy pain are probably not connected to prolapse unless it is very advanced. Prolapse can also give rise to a feeling of being more ‘open’ at the entrance to the vagina, & can sometimes lead to discomfort on lovemaking because of tissues sliding on each other.
What are the symptoms of cystocele & rectocele
Specific problems with a Cystocele can be difficulty starting to pass water, & also not completely emptying the bladder. Sometimes when you get up from the loo, you may want to pee again: a small amount of urine has been trapped in the part of the bladder coming out.
Specific problems with a Rectocele can be incomplete emptying of the bowel, sometimes to the extent that you have to use your fingers to empty it, and again, that feeling of incomplete emptying as some stool can get trapped in the prolapsing bowel.
The other common prolapse is the womb or uterus: it feels different to the walls as it is a solid organ, & the cervix is firm, rather like the tip of your nose. This is a form of prolapse that is likely to need to be fixed.
Factors that cause Prolapse
What factors make some women have prolapse & others not?
- Well some of us are genetically more prone: the tissue that binds our muscles bones & tendons, & forms a basic layer to our skin and organs is called Connective Tissue. This tissue is not as strong in some families where prolapse, varicose veins and hernias may also be common.
- The number of pregnancies and the weights of the babies delivered vaginally are major factors in causing prolapse.
- The loading factors on our pelvis: body weight, constipation, coughing, heavy lifting, & standing for long periods all increase pressure on our tummies which then impacts on our pelvis.
- Getting older, especially with menopause and lack of oestrogen: the 50’s are generally the decade when our bodies catch up with us and the damage caused years earlier in childbirth may reveal itself as prolapse.
Top 5 things to do if diagnosed with prolapse – cystocele or rectocele.
- You probably should have this looked at by your family doctor, who will want to examine you and rule out the possibility of a lump in your tummy or your pelvis causing the symptoms: this is unusual but possible. If you are overweight losing even a few pounds can make a big difference: it will also help you become more active which in itself will keep your weight down.
- Anything that stops you straining will help your prolapse from becoming worse. The commonest issue is constipation. Straining on the loo will weaken further the prolapsing tissues, so you need to soften the stool. Having food on-the-run or in the car, eating a lot of processed food, and not enough fluids or fruit and vegetables are the big issues in our time-poor lives.
- If you have asthma or a poor chest through smoking you will have higher pressures pushing on your tummy and transmitting to your pelvic organs. Stopping smoking & getting your lungs into the best shape possible with your GP is really important.
- Seeing a Women’s Health Physiotherapist is a really good idea for mild prolapse. A programme of exercises to help identify, exercise and strengthen the muscles of your pelvic floor may bear results, although it will take some time.
- EVB Sport & core garment was developed to help women with urine leakage, but is being used by many gynaecologists and physiotherapists for prolapse as well. The garment has been designed using special fabrics of different elasticities and makeup, panelled and layered in a unique way. Pressure is increased on the perineum which helps support the pelvic floor and its organs: however it also takes the load off the pelvis through absorbing the pressures of movement. It is well worth a try while waiting to see a gynaecologist, or while waiting for surgery. If you are more comfortable, you may be happy to continue with EVB into the long term!
Content Credit- Dr Maire Milner – Obstetrician and Gynacologist with over 35 years of experience – Lourdes Hopsital Drogheda and Royal College of Surgeons
Our next Blog will cover the surgical management of prolapse, the various operations, and the controversy surrounding the use if Mesh.
For further information and guide to prolapse the following is an excellent resource: https://pogp.csp.org.uk/system/files/pogp-prolapse.pdf