PROLAPSE REPAIRS
The supporting ligaments of the uterus and the muscles of the pelvic floor and vaginal walls can become stretched and slack. This means that pressure from internal structures, and gravity, will tend to push the vaginal walls, and often the uterus, via the path of least resistance, namely towards the vaginal opening. This may be happening to some degree, and give no symptoms. It can, however, give rise to feelings of pressure, a lump, dragging discomfort or pain, discharge, urinary problems, bowel problems, sexual difficulties, and in more severe cases, a uterus which prolapses beyond the vaginal opening. The prolapsed uterus can usually be pushed back, but if it does not go back readily, the cervix can sometimes become enlarged or ulcerated.
If the front (anterior) vaginal wall is slack the bladder and urethra may slump backward, into the vagina. The position of the urethra and the bladder play a part in controlling flow out of the bladder, so when that is disturbed, the result may be incontinence (lack of bladder control). The capacity of the bladder and how well it empties may also be affected, leading to a tendency for bladder infections.
If the back (posterior) wall of the vagina is weakened, the structures behind it which can slump into the vagina are the rectum and small bowel. This can lead to problems with the bowels, such as constipation, and difficulty in actually passing poo.
The causes of prolapse include damage during childbirth (stretching of the vaginal wall supports, the pelvic floor muscles, or the uterus-supporting ligaments), or a congenital (born with it) tendency to have slacker connective tissues. The prolapse may not be apparent until the intra-abdominal pressure is increased, as it may be in pregnancy, or (more rarely) if there is a significant swelling within the abdomen, or with the passage of time and gradual progression (it is more common in older women).
Aggravating or compounding factors for prolapse include being overweight, having a chronic cough (smoking), or chronic straining (constipation). Adjusting these factors may in fact help alleviate the symptoms considerably. Pelvic floor exercises may also be helpful, and if oestrogen deficiency is noted, replacement either locally or with hormone replacement therapy may be worth trying. However, if the symptoms are troublesome, surgical prolapse repair can be performed.
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