Understanding vaginal prolapse

In his latest online article, Mr William Kuteesa gives us his insights into vaginal prolapse, timely diagnosis and treatment options.

Vaginal prolapse is a common condition that can significantly impact a woman's quality of life. Despite this, many women suffer with this problem for years without seeking help from health care professionals.

What is vaginal prolapse?

Vaginal, or pelvic organ prolapse, is characterised by the descent of the pelvic organs (womb, bladder, bowel) into the vaginal canal. This can lead to discomfort that affects every day activities, cause urinary and bowel symptoms or it can adversely affect sexual function.

Should I seek help to treat my prolapse?

If vaginal prolapse doesn’t cause any symptoms, it does not need treatment. However, it is important to seek an assessment and advice on how to prevent progression of prolapse and to ensure that there are no underlying, easily treatable causes. If prolapse is causing particular problems, effective treatment should: negate symptoms, restore normal anatomy and improve overall well-being.

Who should treat my vaginal prolapse?

General practitioners (GPs) will give advice and initiate some treatments for prolapse.

Specialist physiotherapists can help patients with the symptoms of prolapse and help improve some of the associated bladder and bowel symptoms.

Urogynaecologists are gynaecologists who specialise in treating vaginal prolapse and bladder problems.

How can I prevent progression of prolapse?

Early detection allows healthcare providers to advise on interventions such as lifestyle modifications. These interventions include pelvic floor exercises, weight loss and treating chronic constipation.

What other treatments are available for vaginal prolapse?

Prolapse that significantly impacts a woman's physical and emotional well-being should be treated.

This will generally involve either specialist physiotherapy, vaginal support pessaries or surgery.

Urogynaecologists, will advise on a treatment in partnership with their patient. This should address her specific concerns and symptoms and improve overall quality of life. In essence, the treatment provided should be determined by a woman’s particular wishes.

What are vaginal support pessaries?

Modern support pessaries are devices made from medical grade plastic.They are placed within the vagina to restore normal anatomy and support. They can improve many bladder and bowel symptoms associated with prolapse and some shapes, such as ring pessaries, enable sexual intercourse. There are numerous shapes, sizes and levels of flexibility of pessary. Urogynaecologists will help a patient find a well-fitting pessary that is comfortable and suits her needs.

Women using support pessaries require a review every six to twelve months. At these times their urogynaecologist will confirm the health of the vaginal tissues and may change the pessary. The visits are also an opportunity to assist with other gynaecological health questions.Some urogynaecologists will teach their patients to remove and insert their own pessaries. This enables greater control of her device and ultimately her prolapse condition.

What type of surgery is right for me?

Surgical treatments for vaginal prolapse come in many forms. The techniques used depend on a woman’s preferences and the type and severity of her prolapse. The majority of operations are vaginal, meaning that there are no abdominal cuts or scars. We use stitches (sutures) for these procedures; we do not use mesh. There are types of prolapse that require abdominal cuts, the majority of these can be performed laparoscopically (minimally invasive surgery).

If a patient chooses to undergo surgery, she should expect to be in hospital for one to two nights and avoid strenuous activity for up to six weeks after her operation. It is my view that once fully recovered, a woman should freely return to all the activities she wishes.

Prolapse is a common and often distressing condition. Healthcare professionals should make a timely diagnosis to resolve any treatable underlying causes. The clinician should carefully listen to their patient, understand the specific problems the prolapse is causing, and thus address them with a range of options. The woman and her clinician can then agree the most appropriate treatment, tailored to her particular needs.

Mr William Kuteesa is an esteemed consultant urogynaecologist. You can schedule an appointment with Mr Kuteesa on his Top Doctors profile.