Prolapse. What is it and what can be done.
Prolapse is a medical term describing the slipping of moving of a body part or organ from its normal position. More specifically, in females, Prolapse is often used to describe the falling of the urinary bladder (Cystocele), falling of the uterus and/or vagina, and falling of the rectum (Rectocele). These are common conditions affecting approximately one in three women over the age of 45. When present, most women will have a combination of these conditions.
Prolapse of the Urinary Bladder, fallen bladder, or Cystocele occurs when the wall between the urinary bladder and vagina weaken allowing the bladder to fall or prolapse into the vaginal canal. Women often complain of feeling like something is falling out, feeling a bulge at the entrance to the vagina, and/or feeling like they are unable to empty the bladder completely. Many times this condition is associated with unwanted leaking of urine with coughing, sneezing, or physical activity. This condition is called Stress Urinary Incontinence. Prolapse of the urinary bladder may be caused by giving birth, straining, heavy lifting, chronic coughing, and aging.
Prolapse of the Uterus and/or Vagina, fallen uterus or fallen vagina, occurs when the uterus or top of the vagina falls and descends towards the vaginal opening. Women often complain of similar symptoms as mentioned with cystocles, but in addition often have discomfort and pressure in the pelvic region. Causes are similar to cystoceles with the addition of hysterectomy as a risk factor for developing prolapse of the vagina.
Prolapse of the Rectum, fallen rectum, is often used to describe the weakening of the vaginal wall between the rectum and vagina allowing the rectum to bulge into the vaginal canal (Rectocele). It must be differentiated from rectal prolapse that describes the condition wherein the walls of the rectum protrude through the anus and are visible outside the body. Rectoceles are cause by similar conditions as in cystoceles and often result in symptoms of constipation. Many women will have to splint (placing pressure on the area between the anus and vaginal opening) to have a bowel movement.
Treatment options range from non-surgical with a pessary and pelvic floor exercises, to surgical including vaginal, laparoscopic, and robotic. In the past repair of Prolapse of the bladder, uterus and/or vagina, and rectum were often treated by a team of doctors consisting of a Urologist, Gynecologist, and Colorectal surgeon. Today, a new subspecialty, Urogynecology, trains doctors to manage the entire female pelvis resulting in one doctor having the expertise to treat all pelvic organ prolapse and continence issues. Advances in minimally invasive techniques have reduced hospital says, shorten recovery, and achieve better outcomes. These highly advanced techniques require special training and experience to achieve good results. J. Kyle Mathews, MD