Patient InformationPelvic Organ Prolapse
a) What is Prolapse?
When the muscles of the pelvic floor weaken, and the ligaments of the pelvic organs lengthen, the pelvic organs move down towards the earth. Gravity pulls things down, that’s natural. Naturally, it is common as time passes. About 10% of women will need treatment for prolapse at some stage. The problem can be minimised and treatment avoided, or postponed, in most people.
Prevention is better than treatment.
b) Prevention
How to Prevent or Manage Prolapse.
1. Reduce the forces from above.
Reduce weight if needed
Reduce coughing (cease smoking, have flu vaccination, treat conditions such as asthma)
Avoid lifting heavy weight
Avoid constipation
2. Post Natal.
After having a baby be careful and wait 4-6 months before lifting heavy weights or participating in competitive and extreme sports. After a pregnancy the pelvic floor and uterine ligaments take some months to resume their previous length and strength.
3. Help from below
Maintain and improve the support in the pelvic floor. Pelvic floor exercise works. See a Physiotherapist with special expertise in this area.
4. Use of vaginal oestrogen when needed.
When post menopausal or post natal, topical application of oestrogen to the vagina makes it healthier which makes it help support pelvic organs. Topical oestrogen is not absorbed into the body circulation – as in hormone replacement therapy. It will not affect things such as uterine bleeding, breasts or blood clotting.
c) Treatment for Pelvic Organ Prolapse
Reminder note: Do not stop the preventative measures listed above. They need to be continued, particularly after treatment, because there is a chance the prolapse will recur and treatment needs to be repeated. The type of treatment used will depend on the type of prolapse, the main symptoms, and specific personal needs. When planning treatment it is important to have a realistic understanding of the expected results. There will rarely be a 100% improvement. Associated bladder symptoms may continue or new symptoms may develop.
Pessaries
There is a wide variety of shapes and sizes of pessaries that can be placed into the vagina to support the pelvic organs. Some women have immediate resolution of their prolapse symptoms with a pessary, others need to try several pessaries before achieving success, and occasionally pessaries do not help. Whilst using pessaries vaginal oestrogen is important.
d) Pelvic Repair Surgery
Surgery is best carried out via vaginal incisions (rather than by abdominal operations). Mesh is not used for vaginal repair surgery.
The most common surgery used is to suture the pelvic floor muscles (that have moved outwards) back together. The sutures used dissolve after 6-8 weeks when a follow up examination will check progress and healing. Usually the muscles have healed well by this time and a woman can resume normal activities, work, and pelvic floor physiotherapy (Reminder: remember to take steps to prevent a recurrence of prolapse). Occasionally the wounds take longer to heal and will be uncomfortable, so longer follow up may be needed.
Vaginal hysterectomy with repair
When the uterus is prolapsed and future pregnancy is not planned, vaginal hysterectomy is performed using the same vaginal incision that is needed for the pelvic muscle repair.
After removing the uterus, the top of the vagina is sutured to the ligaments that join the uterus to the sacrum (utero sacral ligaments). When prolapse has recurred the vagina can be sutured to another ligament near the sacrum (sacrospinous ligament). In cases when hysterectomy is not performed the utero sacral ligaments are shortened.
Colpocleisis (Le Fort operation)
This is an alternative repair operation that can be chosen and may be the best choice for severe or recurrent prolapse. It creates another wall along the upper vagina between the front and back walls of the vagina resulting in two vaginal canals. This makes recurrence of the prolapse very unlikely. However this will most likely obstruct the upper vagina to intercourse.
