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Prolapse is a medical condition when the area around the Vagina, rectum, Bladder, Uterus, intestines begin to fall or prolapse out of their normal positions.

Typically the Female Reproductive Structures are held into place by the fascia, ligaments, muscles, and skin. Parts of the system make weaken due to time, age, injury, or others. Vaginal prolapse is also called Pelvic Organ Prolapse.

It is likely that nearly 40% of all women will develop prolapse at some point

It may occur following Menopause, Childbirth, activity, injury, hysterectomy, or other surgery. The typical age is 40 and older.

Many women do not seek medical help because of feeling embarrassed. Some women feel no symptoms. Prolapse is very rarely life threatening. But it can gradually worse over time.

Symptoms

–  Changes to Uterus, Bladder, Urethra, Rectum, or Vagina can be seen
–  Change in sexual functions
–  Change in Urination
–  Changes in Defecation
–  Pelvic Pressure
–  Urine leakage
–  Skin protusion from Rectum
–  Skin protusion from Vagina

Types of Prolapses

1.)  Cystocele   (Prolapse of Bladder)

–  Involves prolapse of front wall of the Vagina
–  Medically related to pubocervical fascia
–  Bladder pushes into vagina
–  Urethra prolapses as well

2.)  Urethral  (Prolapse of Urethra)

–  Happens during Cystocele

3.)  Cystourethrocele

–  When both Bladder and Urethra prolapse at same time
–  Combination of above mentioned prolapses
–  Urine leakage: during cough, sneezing and/or exercise

4.)  Enterocele  (A Herniation of the small bowel)

–  Involves weakening of upper vaginal supports
–  Typically follows a Hysterectomy
–  The front and back wall of the vagina separates.
–  This allows the intestines to push against the vaginal skin.

5.)  Rectocele  (Prolapse of Rectum)

–  Involves prolapse of back wall of the vagina
–  Medically related to rectovaginal fascia
–  Wall weakens, rectal wall pushes into vaginal wall
–  This creates a bulge
–  May become “more” apparent during bowel movements

6.)  Uterine   (Prolapse of Uterus)

• Involves weakness of a group of ligaments
• Medically related to uterosacral ligaments
• Typically at the top of the vagina
• Causes Uterus to fall
• Causes both the front and back vaginal walls to weaken.

Stages of Uterine Prolapse:

1.)  First Degree:  Uterus Droops into upper portion of vagina
2.)  Second Degree: Uterus Falls into lower part of Vagina
3.)  Third Degree: Cervix sags into vaginal opening. It may protude outside body
4.)  Fourth Degree:  Uterus completely protudes outside vagina.  Also called procidentia

7.)  Vaginal Vault  (Prolapse of Vagina)

–  Can occur following Hysterectomy
– Normally the Uterus provides support to top of vagina.
–  After Hysterectomy – 10% may see some degree of prolapse
–  Vaginal Vault Prolapse – top of vagina falls toward vaginal opening
–  Walls of vagina may weaken
–  Can effectively turn vagina inside out
–  Can be seen along with Enterocele.

Causes:

–  Age
–  Childbirth
–  Menopause
–  Hysterctomy
–  Injury
–  Obesity
–  Prior pelvic floor surgery
–  Strenous physical activity
–  Smoking
–  Others

Diagnosis

–  Physical Exam
–  Medical History
–  Q-tip test
–  Bladder Function test
–  Pelvic Floor strength
–  Ultrasound
–  Cystourethroscopy

Treatment

NonSurgical options:

–  Activity Modification
–  Avoid Heavy lifting or straining
–  Pessary – small device – made of Silicone.
–  Kegel Exercises
–  Medications

Surgical options:

1.)  Vaginal vault prolapse

–  Surgery may be done through Vagina or Abdomen
–  Vaginal vault suspension
–  Attaches Vagina to soft tissue in pelvis or to the Sacrum bone

2.)  Prolapsed Uterus

–  If postmenopausal or don’t want to have children
–  Hysterectomy is surgery of choice.
–  This is typically done through Vagina

3.)  Cystocele and Rectocele

–  Surgery through Vagina
–  Incision in vaginal wall and pushes organ upwards
–  Secures vaginal wall to place organ into normal position.
–  Excess tissue is removed.
–  Vagnial wall is closed.
–  If urinary incontinence is present – urethra may need to be supported (Bladder neck suspension)

LeForte Procedure

–  Only done if a woman no longer has desire to have ability to have intercourse
–  Vagina is suture closed.
–  This narrows vagina and pushes up the prolapsing organs.