Prolapse.... the word all my clients fear hearing when attending a Women's Health Consultation.
Over the years speaking about Women's Health issues such as prolapse, has been some what controversial and regarded as a VERY private matter. Our grandmothers and mothers, may not have ever spoken openly about issues relating to their pelvic health with anyone, maybe not even their family doctor.
Over the years we have seen a shift in attitude; we're more open to discussing pelvic issues and are seeing women looking after themselves.
WHAT IS A PROLAPSE? 'Prolapse is caused by a stretching of the ligaments and muscles that support the pelvic organs, causing those organs to drop down' (Hailes, 2020).
WHAT TYPES OF PROLAPSES ARE THERE?
This is the one fact that shocks every women - there are actually FOUR main types of prolapses that can occur:
Uterine Prolapse: the uterus or cervix may drop down towards the entrance of the vagina.
Bladder Prolapse (Cystocele): the bladder falls backwards into the vaginal wall, creating a bulge.
Rectal Prolapse (Rectocele): the rectum falls forward into the vaginal wall, creating a bulge.
Vaginal Vault Prolapse (Post-Hysterectomy): even though you may have had your uterus removed, the cervix can still collapse down towards the entrance of the vagina.
While these can occur individually and on their own, please be aware that more than one prolapse can occur simultaneiously.
WHAT ARE THE RISK FACTORS OF DEVELOPING A PROLAPSE?
Childbirth & Pregnancy
Chronic constipation or always straining to pass a bowel motion.
Chronic respiratory conditions; COPD, emphysema or asthma.
Being overweight
Repetitive lifting; heavy weights, grandchildren or physically demanding occupations.
Previous pelvic surgeries.
WHAT ARE THE SYMPTOMS ASSOCIATED?
Please note that all symptoms are dependent on the severity and type of prolapse present. You may experience all or no symptoms.
Bulge or swelling felt at the opening of the vagina.
Fullness, heaviness or dragging sensation felt inside the vagina or pelvis.
Bladder or bowel incontinence or sense of urgency.
The feeling that you are unable to completely empty your bladder or bowel.
Slow, or intermittent flow or urine.
Having to strain to open bowels or start urine flow.
Low back ache more towards the end of the day.
Severe cases; visually see prolapse.
HOW DO YOU GET DIAGNOSED?
Being diagnosed with a prolapse can be done through a thorough medical history and physical examination, this can be performed by your Gynecologist, General Practitioner or Physiotherapist.
In most cases you will not need to have investigations or scans done for a diagnosis.
HOW DO YOU MANAGE AND TREAT PROLAPSE?
When it comes to managing and treating prolapse it comes down to three options:
Wait & See Approach
Conservative Approach
Surgical Intervention
Without some sort of intervention, symptoms (as listed above) may become worse over months or years, this is very dependent on the individual. There are many great treatments out there now to help successfully manage prolapse without letting it impact your life.
The line of treatment recommended will depend on the severity of your prolapse and symptoms.
Adequate fluid intake.
Maintaining healthy toilet habits & bowel motions.
Restricting heavy lifting and repetitive activities.
Staying fit by doing regular safe exercise.
Pelvic floor exercises to help maintain support structures and reduce symptoms.
Pessary insertion to help support prolapse, reduce symptoms and delay surgery.
Some medications can help keep your vaginal walls and pelvic floor robust.
Surgical intervention by a Gynecologist.
TAKE HOME NOTE: Please do not dread or fear the word PROLAPSE being brought up or found in your consultation. The reality is that 1 in 3 women will have a prolapse (regardless of childbirth). There are so many great treatments out there and advice to help manage your prolapse, that if you are diagnosed with a prolapse it doesn't mean its the end of the world. Diagnosing with a prolapse earlier does show to have better outcomes, so if you are worried please speak to your trusted health professional.
REFERENCES:
Continence Foundation of Australia. (2020, August 26). Prolapse. Retrieved from Continence Foundation of Australia: https://www.continence.org.au/who-it-affects/women/prolapse
Jean Hailes. (2020, January 20). Prolapse. Retrieved from Jeam Hailes: https://www.jeanhailes.org.au/health-a-z/bladder-bowel/prolapse-bladder-weakness
The Royal Australian and New Zealand College of Obsetrictians and Gynaecologists. (2018, July). Pelvic Organ Prolapse. Retrieved from The Royal Australian and New Zealand College of Obsetrictians and Gynaecologists.