What is Prolapse?

When the supportive tissues covering a part of the body weaken or stretch, occurs a bulge, dropping the organ down. This movement of the organ out of its original place is known as Prolapse. There are several types of prolapse, namely,

• Pelvic Prolapse
• Rectal Prolapse

Everything You Need to Know About Prolapse

Pelvic organ prolapse | Symptoms | Cause | When to See | Complications | Treatments | What to expect | Lifestyle

What is Pelvic Organ Prolapse?

The pelvic organ prolapse means when the organs forming a cover or floor to the pelvic area, drop down. Most women are affected by this. The muscles surrounding the pelvic organs hold them in the right place but due to some problems, they might undergo flexing and stretching. Pelvic organs include – rectum, vagina, and uterus.

If there is a pelvic floor disorder then one or more of these organs might stop working properly. There are certain effects of pelvic floor disorder, which include pelvic organ prolapse, urinary inconsistency, and anal problems.

When the pelvic organs come down into or outside the anus or vaginal canal, it is given the following names

• Uterine prolapse
• Urethrocele
• Vaginal prolapse
• Cystocele
• Enterocele
• Rectocele

Why does prolapse occur?

Pelvic organ prolapse is extremely commonly seen in India. Though it is commonly associated with birth trauma especially due to prolonged labour and normal vaginal delivery, this disease is also seen in women who are in the post-menopausal age group. In India malnutrition also significantly contributes to a higher risk of prolapse.

Prolapse predominantly occurs due to a defect in the endopelvic fascia. The endopelvic fascia keeps all the pelvic organs bound to each other. It consists of collagen and other fibroblasts and is predominantly strengthened and acted upon by oestrogen.

In cases of oestrogen deficiency which is predominantly seen in postmenopausal women the endo pelvic fascia undergoes defects, which results in the development of pelvic organ prolapse.

Symptoms of Pelvic Prolapse

It is hard to notice any symptom in particular. The symptoms are not universal i.e. they vary according to the organ affected. If you remain very careful then you may notice the possible signs.

• Lower back pain
• Pain during sexual intercourse
• Constipation
• Feeling unnecessary pressure in the pelvic area
• Problems related to urination
• Problems like blood clotting or spotting during menstruation

Very early stages of stress urine incontinence especially where it is associated only with leakage of very small drops causing just wetness in the vagina can be treated with the help of Kegel exercise.

This typically involves controlled supervision under a physiotherapist which helps in specific strengthening and contraction of pelvic floor muscles which in fact after 3 to 4 months of therapy may help in better control of the urine leak in early stages in social circumstances.

For any form of advanced-stage disease where there is a severe leakage of urine even on the lightest of the activity performing any form of pelvic strengthening is definitely going to have no benefit as a curative therapy for stress urine incontinence.

Causes of Pelvic Organ Prolapse

Urine incontinence can be temporarily caused due to urinary tract infection this is extremely commonly seen in our country.

This requires infection specific treatment. It normally takes 2 to 4 weeks for it to subside. This may require the patient to take a specific course of antibiotics after urine culture.

Clinical examination of urine leak on a partly filled bladder or a full bladder is one of the best methods to diagnose this condition.

If it is also associated with mixed or urge incontinence then one may choose to do a urodynamic study.

There are a few specified causes like,

• Hysterectomy (removal of the uterus through surgery)
• Cancer in pelvic organ which that causes constant disturbance in the abdominal area.
• Obesity can be one of the major reasons as your body encounters flexing and stretching or fat formation in the pelvic area.
• Long-term problems related to Coughing- that can put excessive pressure on your lower abdomen leading to loosening of the muscles.
• Weaker tissues connecting the organs
• Chronic constipation
• Giving birth at a young age because the body parts are not yet ready.

Pay a Visit to Doctor

If you see any of these signs then there is surely some trouble. So it should be a call enough to visit a doctor. Your doctor may suggest some more tests to find out the real deal.

• CT scan of the pelvis
• Ultrasound of the pelvis
• X-ray of the urinary tract
• Magnetic Resonance Imaging (MRI) is suggested

Complications in Pelvic Organ Prolapse

There can be complications due to this. But these are not life-threatening. Complications are primarily related to

• Pregnancy
• Fecal waste disposal
• Infection in the urinary bladder (because of obstruction in urination)
• Kidney problem, because of the problem in the bladder.

You should consult your Urogynecologists in Mumbai such extreme cases.

How It Is Treated?

If prolapse is diagnosed early on routine clinical examination, then it can be treated by strengthening of pelvic floor muscles. There are several ways to treat pelvic organ prolapse. It includes therapies and surgical methods as well. Some of the treatments are:

• Behavioural Treatment
• Mechanical Treatment
• Surgical Treatment

Non-Surgical Treatment

It includes Behavioural treatment and Mechanical Treatment. The former involves doing such exercises as Kegel exercise, which would strengthen the pelvic muscles. While the second type involves providing artificial support to the organs. For example, a device called a pessary can be inserted into the vagina to provide support.

Surgical Treatment

There are two types of surgery for treating this problem

• Obliterative surgery
• Reconstructive surgery

The first one is a major decision. It leads to obliteration or elimination of the vaginal opening to provide support to other pelvic orangs.

The second one ensures a reconstruction of the organs by putting them back in their place through an incision in the abdomen or the vagina. There is a vast range of reconstructive surgery. For example,

• In one type, your organ is fixed with the help of your tissues where the part which is prolapsed is attached to any of the pelvic ligament.
• The second type is called sacrohystropexy. If you want to avoid a hysterectomy then this is the way to go. This treats uterine prolapse in the best way possible. After attaching a surgical mesh to the cervix, the uterus gets pushed upward.
• The third is the colporrhaphy. In it, the vagina is stitched in such a way that the front wall and the back wall get strengthened.
• Another one is known as sacrocolpooexy. This is done to treat the prolapse in the vaginal vault. It is done either with laparoscopy or by attaching a surgical mesh to the walls of the vagina and the tail bone (sacrum).

Also, there are procedures with a mesh or one without it.

Laparoscopic Burch Colposuspension is often the treatment of choice for patients undergoing repeat surgery or for those who do not consent for a mesh.

TransObturator Tape (TOT) is the procedure of choice for a vaginal repair. Patients can expect to experience immediate benefits from the surgery, and recurrence rates are less than 1%.

However, the use of vaginal mesh has been controversial due to the risks associated with it. While it can provide effective results when applied correctly, there’s a small risk of the mesh eroding due to various factors. In some countries, the use of vaginal mesh has been banned due to these risks.

Patients experience immediate benefit on the day of Laparoscopic Burch Colposuspension surgery itself. When the surgery is done correctly the leak stops immediately. This is an extremely rewarding surgery for the patient.

Expectations After Surgery

You can expect a smooth life after surgery. It will solve problems related to pregnancy and other major issues. Doctors advise undergoing the treatment as a permanent solution.

Restrictions after prolapse surgery and Recovery

• Driving
• Heavy exercise

The drip is removed after twenty-four hours. There might be some bleeding in the vagina which can be prevented by using gauze. It is removed only when the bleeding stops. Doctors advise resting for a minimum of three to five weeks. After that, you can be back to a normal lifestyle.

Lifestyle Changes After Surgery

Your main focus should be on maintaining a proper diet as constipation is common. You should drink a lot of water. Healthy eating like fruits and vegetables can cause you a speedy recovery.

People usually think reducing water intake help in treatment of Stress Urine Incontinence. But reducing the water intake can increase the chances of having urinary tract infection.

Even if a woman is experiencing urine incontinence it is not advisable for them to reduce their water intake. Staying well hydrated is extremely important for maintenance of good health of the urinary bladder.

Early stages of stress urinary incontinence, where the leakage is minimal and causes only vaginal wetness, can often be treated with Kegel exercises.

You should avoid doing anything which would put pressure on your pelvic area. You can rely on laxatives and gentle exercises only with the permission of your doctor.

The problem may seem to be a major one but once you decide to face it, you get a solution. You need a positive mindset to fight such diseases.