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Types of prolapse
A prolapse is caused by a weakness which causes a bulge in the vagina. It may involve the womb alone, the vagina alone, or both the womb and the vagina. There are four common types of vaginal prolapse: cystocele, rectocele, enterocele and vaginal vault prolapse. The surgery that is performed will depend on the type of prolapse
- Uterine prolapse occurs when the womb's supports (ligaments) have been torn or stretched, allowing the womb to move downwards.
- A cystocele is a bulge in the front wall of the vagina which allows the bladder to move downwards.
- A rectocele is a bulge in the back wall of the vagina which allows the back passage (rectum) to move downwards.
- An enterocele is a less common type of prolapse in which the small bowel bulges down through the vagina.
- Vaginal vault prolapse occurs in women who have had a hysterectomy previously, the vault (top of the vagina) moving downwards.
Symptoms of a prolapse
Although some symptoms are specific to the type of prolapse, many occur regardless of the type of prolapse. The feeling of a bulge or lump at the entrance to the vagina is the most common symptom. A feeling of pressure is often felt within the vagina or lower abdomen. Many women describe an ache within their pelvis. Most of these symptoms are worse when a woman has been on her feet for some time, especially with lifting and sport. A prolapse can interfere with sexual intercourse, women often finding this uncomfortable. The increased vaginal size and lack of muscle tone may cause intercourse to result in decreased satisfaction for both the woman and her partner.
Women with a uterine prolapse often complain of a dragging pelvic pain, often also felt in their back.
Women with a cystocele often have bladder symptoms, including frequency and difficulty passing urine. Stress incontinence is common, but is commonly absent due to the kinking effect the prolapse has on the urethra.
Women with a rectocele may have difficulty opening their bowels. They may feel that the defaecatory effort is going in the wrong direction, and can be helped by replacing the prolapse with a finger.
Surgery for prolapse
The surgery performed will depend on a number of factors - the type / severity of the prolapse, your symptoms, your desire to remain sexually active and your age / general physical condition. Common operations include vaginal hysterectomy and vaginal repair, vaginal repair, sacrospinous fixation, sacrohysteropexy and sacrocolpopexy.
Vaginal pessaries for prolapse
Many women with a prolapse can be treated using a plastic pessary instead of surgery. Although pessaries are usually used in older women, there is no reason why they cannot be used by women of any age. Not all women will be able to have satisfactory sexual intercourse when they have a ring pessary but many will. Many women are able to remove and replace their own pessaries to enable intercourse.
Fitting a pessary is not an exact science and you may need to try several sizes before finding the correct size for you. They are usually changed every 6 months by your GP or practice nurse. The most common problem is a vaginal discharge caused by irritation of the vaginal skin. This can usually be treated or prevented by the intermittent use of a vaginal oestrogen cream. Antibiotics may also be necessary occasionally.