Prolapse

A genital tract prolapse (pelvic organ prolapse) is a weakness of the supporting structures of the uterus (womb), pelvic floor and vagina.

  • Weakness in the front wall of the vagina (cystocele) is when the bladder is pushing into the vagina
  • Weakness in the back wall of the vagina (rectocele) is when the rectum is pushing into the vagina
  • Weakness in the supports of the uterus can cause a total pelvic prolapse (procidentia)
  • Weakness in the upper part of the vagina can cause a hernia (enterocele)

Prolapsed bladders (cystocele) can cause a variety of problems like discomfort and urinary incontinence. Many women will notice a bulge or a dragging sensation. Usually you will not be able to tell whether it is the bladder or the bowel that is causing the problem! Prolapsed bowels (rectocele) can also cause bladder symptoms as well as bowel emptying symptoms. Your urologist is trained in pelvic organ prolapse and has the skills to manage both your prolapse symptoms as well as any incontinence problems you may have.

 

Treatments

There are simple conservative measures that your urologist may recommend for you as well as surgical options.
Surgery may be done through the vagina or abdomen (tummy) and this will depend on the presence of other symptoms and the type of prolapse. 

Oestrogen replacement
This can be in the form of a cream which is put into the vagina. 

Pelvic floor exercises
These are easy to learn and can be taught to you by our continence nurse specialist. 

Surgery
If conservative treatments do not improve the problem or are inappropriate, then surgery might be an option.

Pessary
A ring pessary can be inserted into the vagina which will hold the prolapse back.

 

Vaginal repair

Cystoceles and rectoceles can be repaired through a simple incision in the vagina. The operation is known by a number of different names, but they are all equivalent:

  • Cystocele repair: anterior vaginal repair or anterior colporrhaphy
  • Rectocele repair: posterior vaginal repair or posterior colporrhaphy

The vaginal approach to treating prolapse is simple and quick to recover from, although you are advised not to do any heavy lifting for six weeks after the operation. It involves an incision (cut) on the inside of the vagina and you will usually stay in hospital for only one night. Treating incontinence at the same time is also straightforward as the surgeon can use the same incision so if you suffer from both incontinence and prolapse, treating both in one sitting is often recommended.

At Urology Associates none of our surgeons will recommend nor perform the vaginal placement of synthetic mesh for prolapse. There have been a number of cases across the world, and particularly in the USA, where women who have had vaginal mesh placement for prolapse have suffered complications. Some of these cases have received intense media coverage. If you have been recommended the vaginal placement of mesh for prolapse, we recommend that you seek a second opinion before proceeding with surgery. In some select cases, this may be the correct option for you, but it is important that you understand the risks and benefits.

 

Transvaginal Mesh

At Urology Associates none of our surgeons will recommend nor perform the vaginal placement of synthetic mesh for prolapse. There have been a number of cases across the world, and particularly in the USA, where women who have had vaginal mesh placement for prolapse have suffered complications. Some of these cases have received intense media coverage. If you have been recommended the vaginal placement of mesh for prolapse, we recommend that you seek a second opinion before proceeding with surgery. In some select cases, this may be the correct option for you, but it is important that you understand the risks and benefits.

Recently there has been a lot of information and controversy in the media and online about the use of mesh so we’d like to take the opportunity to discuss our view around this treatment. Read our latest blog post and find out the truth about transvaginal mesh.

 
 Click the image above to download our Abdominal sacrocolpopexy information booklet

Click the image above to download our Abdominal sacrocolpopexy information booklet

Abdominal sacrocolpopexy

Sometimes the body’s natural supporting structures are weakened and the vagina slips down from its normal position. Weakness of these supporting structures may be due to vaginal childbirth, aging, hysterectomy and changes in your hormone levels.

An abdominal sacrocolpopexy is an operation performed through a cut in the abdomen (tummy). It lifts the vagina or uterus back into its normal position by attaching a piece of synthetic mesh between the top of the vagina and a bone in the lower part of the spine. This is the gold standard treatment for all types of prolapse and is usually recommended as first-line treatment for more severe prolapse problems. As the mesh is placed via the abdomen and not via the vagina, it is considered very safe and is not associated with the complications seen with vaginal mesh placement. Your urologist will discuss if this is right for you.

 
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