Once oestrogen levels drop after menopause, these muscles become thinner, weaker and less elastic.
The vaginal skin may also stretch, which may allow the bladder or bowel to bulge into the vagina. The symptoms of a prolapse depend on individual factors, such as the severity of the prolapse and level of physical activity. A prolapse is diagnosed by a medical history check and a physical examination. The physical examination will determine:. Gynaecologists with a special interest in prolapse use a grading system called the POP-Q system to measure the degree of prolapse in centimetres.
A prolapse is graded by how much the organ or vaginal wall is pushing down into the vagina. The three stages are:.
Without intervention, the symptoms of prolapse usually worsen over time. However, there is a lot you can do to improve the symptoms. Before a prolapse occurs, there may be a slackening in the walls of the vagina, so awareness of this weakening and preventing it from getting worse are vital. Treatment will depend on the severity of the prolapse and the degree it interferes with a woman's lifestyle. In some women, strengthening the pelvic floor muscles and modifying daily activities may be all that is required.
Last updated 04 November — Last reviewed 04 August This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at August Published twice a year, the Jean Hailes Magazine features up to date women's health information that is easy to understand, expertly written and evidence based.
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Back Overview Events Postcards from Search the Jean Hailes website using keywords. On This Page. What is prolapse? There are different types of prolapse, including: Types of prolapse What happens Vaginal prolapse The walls of the vagina become overstretched and bulge downwards towards the vaginal entrance. The bulging can be: the front vaginal wall with the bladder in front of it the back vaginal wall with the rectum immediately behind. Uterine prolapse The uterus womb and cervix opening to the womb drop down towards the vaginal entrance and may protrude outside the vagina. A cystocele usually occurs because of a weakening of the pelvic floor muscles, which support the uterus, bladder and bowel.
A cystocele can occur by itself or it may happen along with other abnormalities, such as a rectocele see below or uterine prolapse. Bowel prolapse also called rectocele When the bowel bulges forward into the back vaginal wall. Your doctor might also recommend a device called a pessary.
Pessaries are made from silicone and come in many different shapes. The pessary is inserted into the vagina to help support the prolapsed organs. It is usually fitted to you, and it's removable. Surgery is an option for women who aren't comfortable with the idea of using a pessary, or who have tried it and found it didn't relieve their symptoms. There are several different types of surgery, based on the location and severity of the prolapse and other health issues.
For women who have uterine prolapse, often a hysterectomy removing the uterus is recommended.
Risk factors for prolapse
Women who are at high risk for repeated prolapse may have a procedure called sacrocolpopexy, in which the surgeon works through small incisions in the abdomen to reposition the pelvic organs back where they should be. They should stop smoking, because it can lead to repetitive coughing," Dr. Disclaimer: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Harvard Women's Health Watch. Procedures that should not be offered 1. Follow-up after surgery 1. Lifestyle modification 1.
Demystifying pelvic organ prolapse
Topical oestrogen 1. Pelvic floor muscle training 1. Pessaries 1. Discussion with the woman should include: the different treatment options for pelvic organ prolapse, including no treatment or continued non-surgical management the benefits and risks of each surgical procedure, including changes in urinary, bowel and sexual function the risk of recurrent prolapse the uncertainties about the long-term adverse effects for all procedures, particularly those involving the implantation of mesh materials differences between procedures in the type of anaesthesia, expected length of hospital stay, surgical incisions and expected recovery period the role of intraoperative prolapse assessment in deciding the most appropriate surgical procedure.
- Pelvic Floor Dysfunction.
- Urinary incontinence and pelvic organ prolapse in women: management.
- Demystifying pelvic organ prolapse.
Surgery for uterine prolapse 1. Surgery for vault prolapse 1. Colpocleisis for vault or uterine prolapse 1. Surgery for anterior prolapse 1. Instead, please see NICE interventional procedures guidance on transvaginal mesh repair of anterior or posterior vaginal wall prolapse , which says: '1.
What to do about pelvic organ prolapse - Harvard Health
Surgery for posterior prolapse 1. These symptoms could include: pain or sensory change in the back, abdomen, vagina, pelvis, leg, groin or perineum that is: either unprovoked, or provoked by movement or sexual activity and either generalised, or in the distribution of a specific nerve, such as the obturator nerve. Investigation Type of mesh Indications Benefits and risks Examination under anaesthesia All types of mesh.
Pain or suspected: vaginal or rectal exposure or extrusion sinus tract, urinary or bowel fistula. Allows diagnosis by direct visualisation. Aids management planning. Anaesthetic risk if carried out under anaesthesia. Risk of bowel perforation. Suspected bowel entrapment around mesh.
Risk factors for prolapse
Suspected adhesions secondary to mesh placement. Anaesthetic risk. Risks of laparoscopy, including bowel injury. Suspected mesh infection. Anatomical mapping of suspected fistula. Anatomical mapping and mesh localisation to guide further surgery. Back pain following abdominal mesh placement with mesh attachment to sacral promontory. Identification of discitis or osteomyelitis. Shows implanted material and complications nearby. Shows location of mesh in relation to the vaginal wall and sacrum. Voiding dysfunction. Suspected infection. Suspected urethral mesh perforation.
Anatomical mapping to guide excision surgery. Shows implanted material and local complications. Identifies mid-urethral slings. Shows location of mesh in relation to the vaginal wall and urethra. Urinary incontinence. Managing vaginal complications 1. Managing urinary complications 1. Managing bowel symptoms 1. Terms used in this guideline This section defines some of the terms that are used in this guideline.
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