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Overview

Genital prolapse is the protrusion of a pelvic organ beyond its normal anatomical place. Genital prolapse or Vaginal prolapse is a term involving uterine prolapse, bladder prolapse, rectal prolapse, small bowel prolapse and vaginal wall prolapse.

Mild degrees of uterine prolapse, bladder prolapse or rectal prolapse may not cause any discomfort. However a substantial prolapse may cause a dragging feeling down below, constant backache and a feeling of fullness or even a bulge in the vagina. A severe uterine prolapse may cause pelvic pain, pressure and it may interfere with sexual intercourse. If the cervix (bottom part of the uterus) is protruding near or outside the introitus it may become inflamed, infected or even ulcerated.

Image - Prolapsed Uterus.

A bladder prolapse may interfere with voiding (passing urine) and give urinary symptoms like difficulty to pass urine, tenesm (a sensation of full bladder even after passing urine), frequency or pelvic pressure. Sometimes it is associated to stress urinary leakage which could be particularly embarrassing. A rectal prolapse may cause pressure in the rectum, a feeling of fullness, a bulging mass in the vagina, constipation or a feeling of incomplete emptying the rectum. When it becomes severe evacuation may not be possible unless digital manipulation of the posterior vaginal wall is done.

Any prolapse may have a detrimental effect on sexual intercourse by interfering with penetration and by lack of vaginal wall tones.

Although the exact cause of a prolapse may not be known, risk factors associated have been identified like difficult or prolonged deliveries or delivery of big babies.

Image - Prolapsed Bladder.

A patient may elect conservative treatment when she has a very high surgical risk or when she just does not want to have a surgical procedure. This involves mainly the use of pessaries that are plastic devices inserted inside the vagina and above the level of the pelvic floor muscles to keep the prolapsed structures in their anatomical place. However, as they are foreign bodies they may cause infections, tears of the vaginal walls, bleeding and interference with sexual activity. They need to be replaced every 3-4 months. They will not correct the prolapse but they may bring temporary relief. The surgical treatment aims to relieve symptoms, restore the anatomy of the pelvic floor, restore the bladder and bowel function and keep a normal vaginal capacity for sexual function.

The traditional way of repairing a prolapse uses a complete vaginal approach. More recently however, advanced laparoscopic techniques have been developed as the laparoscope allows a very detailed examination of all the pelvic anatomical structures. In these sort of situations the Gynaecologist has the advantage of a combined vaginal and abdominal access to perform a more complete pelvic floor reconstruction. The repair “from the top” can be accomplished through the laparoscope with minimal skin incision and a comfortable recovery.

Photos

WARNING: Contains intra-operative images.

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