Pelvic prolapse

Definition:
Prolapse literally means “to fall out of place”, from the Latin prolabi meaning “to fall out”. In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place.

As the muscles, ligaments and supporting tissues in the pelvis become weaker, they are less able to hold in the organs of the pelvis such as the womb (uterus) or bladder.

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Gravity pulls these organs down and, in the more severe cases, may appear through the entrance to the vagina.

A variety of problems can occur, depending on where the weakness lies and which organs are able to descend, but in every case there is some degree of prolapse of the vaginal wall, which begins to invert (rather like a sock turning inside out).

•Prolapse of the womb or uterus is the most common prolapse, affecting as many as one in eight older women to some degree
•Prolapse of the bladder, known as a cystocele, is less common.
•Prolapse of the urethra (the tube that carries urine out of the bladder) is known as a urethrocele.
•Prolapse of the intestines is quite rare, and known as an enterocele or rectocele.

Some experts say up to 50 per cent of women who have had more than one child will eventually develop a prolapse .

Symptoms:
Symptoms depend on which tissues descend, and how severe the prolapse is.

They may include:
•A sense of heaviness or pressure in the pelvis.
•The appearance of a bulge of tissue in the genital area, which can be quite alarming, and is often red and sore.
•Urinary problems, such as having to urinate more frequently, feeling the need urgently, being incontinent (losing control of the bladder) or, conversely, being unable to pass urine when you need to.
•Pain in the pelvis or lower back.
•Sexual problems, including pain and decreased libido.
•Constipation.
•Vaginal discharge or bleeding.

 

Causes:

Several factors make a prolapse more likely. They include:

•Age: prolapse is rare in young women. As a woman passes the menopause and levels of the female hormone oestrogen decline, the supporting tissues of the pelvis can lose their elasticity and strength very quickly.

•Pregnancy and childbirth: this is one of the most important risk factors for prolapse. Pregnancy stretches and strains the tissues of the abdomen and pelvis. Then during labour and delivery of the baby, the pelvic floor is stretched as the baby passes through. Trauma, tears or lacerations during delivery compound the problem.

•Genetics: research has shown that younger women who develop a prolapse have up to 30 per cent lower levels of collagen (the fibres that form the internal scaffolding of the tissues). This suggests there may be a genetic predisposition, and it certainly seems to run in some families. It is also more common in certain inherited conditions such as Marfan’s syndrome and Ehlers-Danlos syndrome, where there’s abnormal collagen production.

•Muscular defects: uterine prolapse can occur very occasionally in tiny babies who have a weakness of the pelvic muscles or problems with the nerve supply to the area.

•Wide pelvic inlet: this is the round gap in the base of the pelvic bones, through which the baby passes during birth and women with this are more at risk because the tissues bridging the gap have to work even harder to hold the organs above in.

•Chronically increased pressure inside the abdomen: due to obesity or lung disease, for example, helps push the organs down and out.

 

Risk Factors:
Some of the risk factors for pelvic prolapse include, multiple vaginal births, especially large babies, prolonged labor, chronic conditions such as diabetes, COPD (chronic obstructive pulmonary disease), obesity, and finally genetic factors.

 

Treatment:
Pelvic prolapse in women is a very common condition that is sometimes avoided by patients and their caretakers. This is a general terms that describes the weakening of the tissues, and ligaments that give support to the uterus, vagina, bladder, and rectum.

Treatment will depend on the type of pelvic organ prolapse you have. Your doctor may recommend first treating some types without surgery. However, in most people, surgery is eventually necessary.

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*Medications. Menopause results in lower estrogen levels, which weakens the muscles of the vagina. Estrogen replacement therapy (ERT) may strengthen these muscles. However, some people shouldn’t use ERT. If you develop symptoms of one type of prolapse, you’re more likely to develop other types.

*Physical therapy. Physical therapy can include electrical stimulation and biofeedback.

*Electrical stimulation. During electrical stimulation, the doctor applies small electrical currents to certain muscles in your vagina or pelvic floor. The current causes your muscles to contract, which strengthens them.

*Biofeedback. As you perform pelvic floor exercises, a sensor monitors muscular contractions to determine if the exercises affect certain muscles.

*Surgery.  Doctors may use robot-assisted surgery to treat some types of pelvic organ prolapse. Robotic surgery allows your surgeon to make smaller incisions and can shorten your hospital stay. There are different strategies for various types of prolapse.

*Rectal prolapse (rectocele). Your surgeon will secure the tissue between your vagina and rectum to keep the organ in its proper position. Your surgeon also removes excess tissue.

*Bladder prolapse (cystocele). Your surgeon will push your bladder up and secure the connective tissue between your bladder and vagina to keep the organ in its proper position and remove excess tissue. If you have urinary incontinence, your doctor will use a bladder neck suspension or sling to support your urethra.

*Uterine prolapse. If you’re postmenopausal or don’t want more children, your surgeon may perform a hysterectomy to correct uterine prolapse.

*Vaginal vault prolapse and herniated small bowel (enterocele). These often occur high in the vagina, so your surgeon may perform the surgery through the vagina or abdomen (for severe vaginal vault prolapse). Your surgeon will attach the vagina to the tailbone at the base of the spine (vaginal vault suspension).

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Non-surgical pelvic prolapse treatment can be 60 to 70% successful if the prolapse is identified early. These non-invasive pelvic prolapse repair modalities include Kegel exercises, biofeedback, and the use of pessaries.
Prevention:
Women need to be aware of the risks of prolapse and the steps they can take to avoid it, including maintaining a healthy weight, eating plenty of fruit and vegetables to avoid constipation, and learning correct lifting techniques.

There are also specific exercises to keep the pelvic floor muscles strong, sometimes known as Kegel exercises. For example:

•Empty your bladder fully and then, while still sitting on the toilet, practice squeezing your pelvic muscles as if you were trying to stop the flow of urine (don’t do this while actually urinating as it can cause a potentially harmful backflow within the urinary system).

•Practise holding specially designed weighted cones within the vagina.

•Once you have some awareness of the ‘feel’ of the pelvic floor muscles, repeatedly contract them (but not the gluteal or buttock muscles) 50 to 200 times a day for a few seconds at a time.

•Some women find it hard to become aware of, and so exercise, their pelvic floor muscles. There are a number of devices that can help. These are put in the vagina where they either mechanically or electrically trigger the muscles to contract automatically. They are fairly simple to use, very discreet and have been shown to improve continence.

You can get expert advice on pelvic floor exercises from a physiotherapist, who’ll be able to teach you the techniques involved. Your GP may be able to refer you to one, or to a local incontinence clinic where the nurses are also trained on this issue.

It’s also important to aim to minimise trauma to the pelvic tissues during childbirth. Some physiotherapists and also some midwives specialise in teaching women how to strengthen their pelvic floor muscles before giving birth, and retrain them after the stretching of the tissues that occurs during delivery of the baby.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

 

Resources:

http://www.mayoclinic.org/pelvic-organ-prolapse/treatment.html

http://my.clevelandclinic.org/ob_gyn/womens_health/urogynecology_pelvic_floor_disorders/pelvic_organ_prolapse.aspx

http://www.bbc.co.uk/health/physical_health/conditions/pelvic_prolapse.shtml

http://en.wikipedia.org/wiki/Prolapse

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