Pelvic Floor Problems and Prolapse
Prolapse of the vagina or womb is a common problem affecting the quality of life of millions of women, particularly following childbirth, where the pelvic floor muscles are weakened. As a result, the muscles may fail to properly support the pelvic organs, causing these to descend into the vagina.
There are several treatment options available for women who are suffering from prolapse and not all of them require surgery. Treatment should be tailored to the individual woman, with the main purpose of alleviating her symptoms. It should also take into account whether the woman is sexually active and whether she intends to have further children.
Treatments for pelvic organ prolapse include:
- Conservative treatments, such as lifestyle changes
- Vaginal pessaries
- Surgical procedures
Many women do not require treatment for pelvic prolapse, as the problem frequently goes away by itself and does not greatly interfere with normal day-to-day activities.
However, some treatments exist which are low risk and simply involve small lifestyle changes. This includes reducing or stopping activities which involve straining, such as the avoidance of heavy lifting. Health professionals also recommend continuing your pelvic floor exercises (Kegels) and ensuring you maintain a healthy weight.
Additionally, it is recommended that constipation be avoided by eating a high-fibre diet, so as to avoid putting extra strain on these muscles when going to the toilet. If you are a smoker, your doctor will recommend quitting, since coughing can aggravate prolapse.
If these treatments do not work, undertaking a pelvic floor muscle strengthening programme under the care of a dedicated Women’s Heath physiotherapist may be recommended. This is also important for prevention of recurrence of prolapse after surgery or development of a new prolapse in the vagina where prolapse was not present before.
If conservative measures have been unsuccessful in alleviating the symptoms of prolapse, a vaginal device may be used.
There are several devices which can be used, with the most common instrument being a ring pessary. These are removable devices that are placed into the vagina to support the prolapsed organs and keep them in place.
Ring pessaries are popular because they do not block the vagina and are therefore compatible with sexual intercourse. They need to be replaced every six months, but otherwise should not be felt or prove bothersome, thus not preventing any activity the women wishes to undertake.
Alternatives to the ring device include the shelf, Gellhorn and cube pessaries or variations. These devices block the vagina and are therefore not compatible with sexual activity, with the exception of the cube pessary, which has a mechanism for insertion and removal by the patient herself, meaning it can be taken out and re-inserted before and after sexual intercourse.
The advantage of vaginal pessary devices is that they confer much less risk than surgery and can be inserted and replaced in the outpatient setting without the need for anaesthetic of any kind.
The disadvantage of these devices is that they may fail. This means that they may be displaced from the vagina by the prolapse, despite trying different sizes or different devices. This method is also an ongoing treatment, requiring repeated appointment attendance, which for some women may not be practical. The final drawback of vaginal pessary devices is that they can produce a vaginal discharge which some women do not like.
If pain and discomfort continues as a result of pelvic organ prolapse, which cannot be eased by making relevant lifestyle changes or through use of pessaries, then surgery may be the best option. Surgery for prolapse is relatively common, with almost 1 in 10 women undergoing it by the time they reach 80 years old.
There are a variety of surgical options for women with vaginal prolapse symptoms and these will depend on the organs involved, the severity of the prolapse and any other medical conditions existing. Surgery options include vaginal repair, vaginal hysterectomy, uterus preserving prolapse surgery and vaginal and perineal reconstruction.
We carry out almost all our procedures for prolapse through minimally invasive means through the vagina. This means that there are no cuts or stitches on a woman’s abdomen and recovery is faster, with shorter hospital stays. We also offer a range of laparoscopic procedures alongside our advanced laparoscopic surgeon.
Due to the collaborative nature of our service, we offer a comprehensive gynaecological service since our consultants frequently operate together to manage women with other gynaecological conditions closely associated with prolapse or pelvic floor problems, such as period problems or endometriosis.
Click here to download information sheets regarding procedures for prolapse.