Genital prolapse

What is it?

A genital prolapse of the internal organs, such as the uterus, bladder, rectum or small intestine, means that these organs slip down through the vagina. The female pelvis is divided into three sections or compartments: The front part (anterior compartment) consisting of the bladder and urethra, the middle part containing the vagina and uterus and, finally, the posterior part (posterior compartment) containing the rectum and part of the small intestine. These three compartments are closely related and therefore influence each other significantly.

The prolapse will be named differently depending on the pelvic organ that is sagging.

1. The cystocoele: Sagging of the bladder through the front wall of the vagina

2. Uterine prolapse: Uterine prolapse, with the top of the vagina.

3. The elythrocoele: sagging of parts of the small intestine through the top and back wall of the vagina.

4. The rectocoele: the sagging of the rectum through the back wall of the vagina.

Prolapse often includes, to a greater or lesser extent, a combination of organs from the three different compartments.

Two factors play a role in this: (1) When there is an increase in pressure in the abdominal cavity on a chronic basis and/or (2) When the supporting function of the pelvic floor weakens, genital prolapse may occur. Increased pressure in the abdominal cavity is typical for people who cough a lot, people who are overweight and people with chronic constipation who have to strain during bowel movements. Reduction of the support function of the pelvic floor is due to damage to the collagen and the muscles in the small pelvis. This can occur as a result of pregnancy and childbirth, ageing and menopause, muscle diseases or congenital connective tissue abnormalities. Previously, when the uterus was surgically removed, there was also a significantly increased risk of sagging.

Symptoms

• Symptoms worsen over the course of the day
• A tired and heavy feeling around your vagina (sagging or feeling a small ball)
• Lower back pain
• Pain in the lower abdomen
• Urinary incontinence
• Difficulty urinating
• Difficulty with stools
• Reduced sensation during sexual intercourse

Not all symptoms are always present. Also, the seriousness of the symptom does not always correspond to the severity of the sagging.

There are actually two prolapse treatment options:

1. A pessary (vaginal ring) is a flexible plastic ring that is inserted into the vagina that, thanks to its shape and size, pushes the prolapsed organs back into place. The ring itself should, therefore, remain in place and be cleaned or removed from time to time. This is upon the condition that there are still sufficiently strong pelvic floor muscles on which the ring itself can lean so that it is not coughed or squeezed out during pushing. This type of ring is usually very well tolerated. Some women experience vague annoyance only during the first few days after the vaginal ring is inserted. Rarely does the ring cause any blood loss or increased secretion.

2. Surgery: If you experience too much annoyance due to the prolapse, a surgical procedure (‘sewing up’) is actually the only efficient way to return the pelvic organs more or less to their original position.
In our department, we usually apply the technique of robotic-assisted sacrocolpopexy. The principle of sacrocolpopexy is already old, and it is known that restoration is well preserved over the long term with this procedure. This intervention has been performed through keyhole surgery since the 1990s so that the pain afterwards, the duration of the admission and the recovery period have been considerably reduced in comparison with conventional surgery. During the procedure, plastic meshes are used to strengthen the anterior and/or posterior vaginal wall. These are then neatly attached to the lower lumbar vertebrae, which pulls the vaginal wall and the top of the vagina back up again.

Latest publication date: 12/12/2023
Supervising author: Dr Ameye Filip