Treatment options for pelvic-organ prolapse
Posted on 8 May 2017
When the bladder, bowel or uterus drops from its normal position in the abdomen and pushes against the walls of the vagina and down towards the vaginal opening, this is called ‘prolapse’. It can happen when the muscles that hold your pelvic organs in place get weak or stretched, and is an uncomfortable and potentially embarrassing condition – but it’s treatable.
What is prolapse?
‘This is a broad term that describes any herniation of the pelvic organs beyond the vaginal walls,’ says Dr Ludgwig van Zyl, a gynaecologist and obstetrician with a special interest in prolapse and pelvic-floor surgery, who operates out of Mediclinic Vergelegen. ‘Although many women blame the bladder for this problem, the uterus and the bowel can also prolapse.’
What causes prolapse?
‘There are several risk factors, of which vaginal delivery in childbirth is the most significant,’ says Dr van Zyl. ‘We hardly ever see prolapse in women who haven’t had children – but this doesn’t mean it doesn’t happen to them, because there are other factors that can be related to prolapse, such as genetic collagen abnormalities that result in connective-tissue disorders.’
Other risk factors include age (the older you get, the higher the risk), being overweight, and if you’ve had a hysterectomy, because removing the uterus can sometimes leave other organs in the pelvis with less support. ‘There are also lifestyle risk factors, such as chronic constipation,’ adds Dr van Zyl.
What are the symptoms and signs of prolapse?
This depends on what stage the prolapse is at, explains Dr van Zyl, but ‘the most common symptom is a sensation of bulging or protrusion in the vagina. Many women say that it feels as if something is falling out.’
Sometimes a self-examination will reveal tissue protruding from the vagina. Prolapse may also cause difficult or painful sexual intercourse. Some women report a slow urine stream and difficulty emptying their bladder, or incontinence of various kinds (stress incontinence, which is an involuntary leaking of urine when pressure in the abdomen increases suddenly; or urge incontinence, when there’s a sudden need to rush to the loo and sometimes not getting there in time). There can also be rectal issues, such as difficulty defecating.
‘Something a lot of people don’t talk about is vaginal splinting,’ says Dr van Zyl. ‘This requires inserting a digit, usually a thumb, into the vagina to manually put pressure on the bladder or rectum in order to properly empty it. Vaginal splinting indicates severe prolapse and you must see your doctor immediately.’
How is prolapse diagnosed?
‘A clinical examination by a knowledgeable pelvic surgeon is vital,’ says Dr van Zyl.
What are the treatment options?
For milder, early-stage and asymptomatic cases, Dr van Zyl notes that surgery is not indicated. Non-surgical options include a soft-ring pessary, which is inserted into the vagina and basically holds everything in place; and physiotherapy overseen by a properly qualified and experienced pelvic-floor physiotherapist.
‘Once the bulge has come through the vagina, surgery is necessary,’ says Dr van Zyl. He stresses that the condition can recur, so it’s vital to try to get it right first time around. ‘You must be evaluated by a pelvic-floor surgeon and the surgery should be planned with special reference to the degree and type of prolapse,’ he says.
Surgery can involve a minimally invasive procedure done through the vagina, in which a tissue repair is done (using either the patient’s own tissue or artificial mesh), with tissue being fixed onto ligaments in the pelvis.
For more severe cases, laparoscopic surgery (in which a thin tube is put through a cut in the belly to look at and/or treat abdominal organs) or open-abdomen surgery may be indicated, which addresses all the different facets of the prolapse. Recovery time from this kind of surgery can be up to six weeks.