Pearl obstetrics | gynaecology


Prolapse

  • prolapse
    Prolapse repair

Vaginal Prolapse | Glengarry Private Hospital, Perth

A prolapse occurs because of weakness & damage to supporting tissue in the pelvis. The most important contributing factors to prolapse are genetic, increasing age and damage due to the effects of childbirth. The most recent research shows that age of first baby and whether forceps are used to deliver are the most important childbirth-related risk factors for significant damage to the pelvic floor. Other contributory factors are the size of your babies, whether you’re menopausal, chronic coughing, chronic straining when constipated or heavy lifting. The classic pattern is for damage to occur to the pelvic floor during childbirth in women who are vulnerable to that damage. This is then compensated for to some extent by other muscles when younger. However, when the menopause occurs, muscle & tissue strength weakens and the effects of the damage from years ago are then seen.

There are several types of prolapse, that may occur in isolation or together.

  • Bladder prolapse or cystocele. This is where the bladder presses downwards creating a bulge at the front of the vagina
  • Rectal prolapse or rectocele. This is where the large bowel presses at the back of the vagina creating bulging
  • Enterocele. This is where bulging occurs at the top of the vagina, caused by the small bowel. Usually seen with a rectocele.
  • Uterine prolapse. This is where the whole womb comes down from the top of the vagina

Prolapses generally aren’t dangerous, just uncomfortable and very annoying, with aching pain and bulging being the commonest symptoms. Interference with intercourse, urinary and bowel symptoms can occur. There are several options for treatment.

Doing nothing

This is a reasonable choice. Many women manage with prolapse that cause little trouble. Some prolapses never worsen. Some however do, and that’s when referral is made for assessment & management.

Physiotherapy

Physiotherapy with guided pelvic floor muscle training can be very helpful in prolapse, especially with mild-moderate types. Benefits are usually only maintained if the exercises are continued. Research shows that most do not continue these exercises long term.

Ring pessaries

A plastic ring device is placed in the vagina which holds the tissues in. These have to be changed every 6 months or so and can cause erosions to the vaginal skin. They are suitable for women who do not want surgery, whether through choice or because they have medical issues that increase surgical risk.

Surgical repairs of prolapse

  • Cystoceles are repaired using an anterior vaginal repair with the body’s own tissue to retighten the vagina.
  • Rectoceles are repaired in the same way by tightening, but at the back of the vagina
  • Enteroceles are repaired at the same time as a rectocele
  • Womb prolapses are usually repaired by means of a vaginal or laparoscopic hysterectomy with a vaginal vault suspension

Recovery is hopefully steady over a period of some weeks. You do have to avoid lifting and strain for at least 6 weeks and preferably 12 weeks following surgery for prolapse. Possible complications are infection, bleeding, problems with the anaesthetic, pain, recurrence of the prolapse and problems with the bladder. We’ll discuss all these and more in detail should you be considering surgery.

 

Older women are more likely to opt for non-surgical options. Younger women generally prefer surgical repair.

Mesh repairs (note: we have never done these)

The use of mesh is very controversial. There are undoubtedly some patients who benefit from prolapse repair with mesh, especially if they’ve had repairs previously and their tissue isn’t good at holding stitches & healing. However the risks are overall higher than repair with the patient’s own tissue. There are a fair proportion of women who suffer with chronic pain, erosion & other problems after having a repair with mesh. Some of these issues take years to develop. The mesh is difficult to remove. We have never used mesh for prolapse repair, but if we feel that you may benefit then you could be referred to a subspecialist for consideration of this approach.
Any surgical or invasive procedure carries risks. Before proceeding, you should do your own research. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. For instance, your GP’s opinion will be very helpful.

Call us if you would like an appointment to diagnose your symptoms and discuss treatment.


Prolapse

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PEARL obstetrics | gynaecology

obstetrics | gynaecology Our office is situated opposite Glengarry Private Hospital in Perth. We provide easy free parking. We're easily accessible from Joondalup, Hillarys, Stirling, Currambine, Ocean Reef, Beldon, Connolly, Edgewater, Wanneroo, Burns Beach, Sorrento, Padbury, Marmion, Watermans Bay, North Beach, Karrinyup, Gwelup, Carine, Balcatta, Westminster, Mirrabooka, Malaga, Hamersley, Koondoola, Girrawheen, Marangaroo, Greenwood, Warwick, Madeley, Darch, Wangara, Kallaroo, Craigie, Heathridge, Woodvale, Scarborough, Doubleview, Innaloo, Osbourne Park, Wembley Downs, Tuart Hill, Trigg, North Beach. The Western suburbs (Cottesloe, Claremont, City Beach, Floreat, Swanbourne) are all within easy reach.