Prolapse and Pelvic Floor problems are very common conditions that affect millions of women. They are associated with childbirth and menopause and can be a cause of discomfort, embarrassment and loss of self-esteem. Prolapse can affect urinary, bowel and sexual function and significantly affect a woman’s quality of life.
When should I get treatment for pelvic floor problems or prolapse?
After childbirth, some women experience weakening of the pelvic floor muscles. These muscles and their attachments support the pelvic organs in women and when they are weaker, there may be some descent of these pelvic organs into the vagina. This may lead to prolapse of the womb, bladder or rectum into the vagina producing a lump or lumps.
Some women have prolapse and have no symptoms, they are unaware that they have a prolapse and it does not affect their life. Sometimes a prolapse is incidentally discovered, for example at a smear appointment.
In many women a prolapse of the uterus or vagiana produces a feeling of a lump or dragging feeling. This may affect urinary, bowel or sexual function. If you have these symptoms then treatment is appropriate.
Symptoms of prolapse
- feeling of a lump in the vagina
- dragging sensation
- inability to retain tampons
- slow urinary flow or incomplete emptying of the bladder
- feeling of needing to go to pass urine frequently, or urgency, and urge incontinence
- difficulty emptying the bowels with associated straining
- feeling that the bowels are not emptying properly
- using a finger to push a lump back to help empty the bladder or bowels
- the feeling of an obstruction when having sexual intercourse
- difficulty achieving penetration when having intercourse
- a feeling of vaginal laxity during sexual intercourse
Pelvic floor weakness is caused by multiple factors and is still not clearly understood. It is associated with childbirth, menopause, and daily activities that lead to straining such as constipation, or persistent coughing and jobs or activities that involve repetitive straining or lifting.
These factors will be addressed or mitigated to lead to the best possible results of treatments.
Assessment of pelvic floor or prolapse symptoms
This will involve taking a detailed history, examination of the abdomen, and a pelvic examination. Examination of the pelvis is an internal examination that takes place with the woman on her back, but may also include assessment in the standing position to best represent her symptoms.
Further investigations may involve urodynamics to assess bladder function, or an ultrasound to assess the pelvic floor and to exclude a pelvic mass, a rare cause of prolapse, if it is suspected.
Prolapse can involve the front wall or roof of the vagina (anterior) or the back wall or floor of the vagina (posterior), it may also involve the womb (uterus). These conditions are not exclusive to one another, therefore a patient may have prolapse of one or both of the vaginal wall with or without prolapse of the womb.
Treatment for this problem should take into account the effect on quality of life and is individualised to the woman. For some women surgery is the best option, but for others a conservative approach is more appropriate. This should be discussed and all possibilities explored.