Prolapse 101

Prolapse is a common condition for women, affecting approximately 50% of mums and 30% of all women. It happens when one or more pelvic organs push into the vagina and descend due to loss of support from muscles, ligaments, and other pelvic tissues and structures.

Let’s explore prolapses involving the bladder, uterus, and rectum.

Prolapse is not a life-threatening condition. Generally, all organs involved remain healthy. It can happen slowly and progressively, or it can occur suddenly, due to significant aggravation from a physical task, such as moving the fridge by yourself.

Women are often surprised when they are told at a routine check-up that they have a prolapse. This is because, in its early stages, a prolapse is most likely asymptomatic. This stage of prolapse is so common that nowadays it’s frequently considered normal, especially for menopausal women.

For many, prolapse will remain asymptomatic forever. However, for others, it will progress and become uncomfortable or painful, with a heavy toll exacted in many areas of life.

Why does it happen?

There can be more than one single cause of organ prolapse. Here are the most common contributors, in no particular order:

• Family history of prolapse.
• Collagen-associated disorders e.g. hypermobility.
• A condition resulting in chronic coughing e.g.: lung disease or hay fever.
• Presence of pelvic tumours e.g.: fibroids or cysts.
• Pregnancy, especially with twins or triplets.
• Vaginal childbirth especially with long, forceful labour, fast descend, forceps.
• Weak connective tissue (Varicose veins starting at a young age, stretch marks, cellulite, joint issues).
• Pelvic floor muscles that lost their optimal condition.
• Stretched pelvic ligaments.
• Chronic slumped posture.
• Heavy physical labour.
• Menopause/Aging.
• Obesity/overweight.
• Straining on the loo/constipation.
• Running, jumping, playing sports or other activities with high intraabdominal pressure performed with ignored loss of bladder control and without pressure management.
• A hysterectomy or other pelvic surgery

These factors will have increased influence during “hormonal” times (menstruation, pre/postnatal, menopause).

How do you know if you have a prolapse?

If the prolapse progresses, during later stages, symptoms may include:

• The feeling of “sitting on a ball”, “something is coming down”.
• Pelvic floor pressure, heaviness.
• Vaginal looseness.
• A bulge near the mouth or out of the vagina.
• Bladder/bowel emptying issues.
• Incontinence.
• The need to memorise the toilet map of town.
• UTIs.
• Pain/discomfort during intimacy.
• Spotting.
• Increased vaginal discharge.
• Inability to retain a tampon.
• Lower back/pelvic pain.

Bladder Prolapse

Bladder prolapse, also known as cystocele, occurs when the bladder pushes into the front vaginal wall and then sinks toward the vaginal mouth.

This is the most common type of prolapse, accounting for more than a third of all prolapses. Engaging in activities with a very heavy bladder can contribute to this condition, as can a full bladder during childbirth.

If you have a cystocele, you may find it easier to empty your bladder by leaning forward, with an anterior pelvic tilt.

Uterine Prolapse

Uterine prolapse occurs when the uterus (or womb, where a baby develops) sinks down into the vagina. Uterine prolapse is the second most common type of prolapse, accounting for almost 20% of all prolapse cases. You have a higher chance of experiencing uterine prolapse if you have a retroverted uterus or fibroids.

It’s easy to self-examine for uterine prolapse by inserting one or two fingers of your dominant hand into your vagina, in search of your cervix, while standing. The cervix feels like the tip of your nose: a hard bulb with an indent in the middle. If you bump into it easily, it’s close to the mouth of your vagina, which means that it’s time to consult your health care provider.

Rectocele

The rectum is the last 12-15 centimetres of the large intestine, just above the anal canal. A rectocele (sometimes called a proctocele or a posterior vaginal wall prolapse) occurs when the rectum bulges into the vaginal space. Approximately 40% of women routinely examined have rectocele present. You have a higher chance of experiencing a rectocele if you had a tear/cut into the anal passage during childbirth, or if you extensively delay bowel waste or gas from passing.

Rectocele-specific experiences include:

• Hemorrhoids.
• Difficulty with bowel movement, the need to strain.
• Multiple urgencies to poop.
• Fecal incontinence

If you have a rectocele, you may find bowel emptying better while leaning back, with feet flat on the ground and an obvious aim to keep bowel emptying a smooth event.

Note:

Rectocele is not the same as rectal prolapse, where the rectum falls down on itself and protrudes outside the body.

If you suspect that you have a prolapse, consult your health care provider. It’s also a great idea to be routinely screened along with your pap smear, for example, as if you know you have a prolapse, you can take early action to reverse this structural defect and prevent it from progressing. There are several treatment options including internal organ support from a vaginal pessary (can be fitted by a physio) or surgery.

Research tells us that prolapse responds POSITIVELY to pelvic floor exercises and supportive lifestyle elements, so you CAN make a desirable difference

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Read Prolapse 102 here.

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