Introduction
As the name implies, uterovaginal prolapse can involve prolapse of the uterus, the walls of the vagina, or both. It is a common problem mainly seen in post-menopausal women
Causes
The uterus is usually well supported by a hammock of ligaments keeping it sitting high up in the vagina. Stretching and damage to these ligament supports during pregnancy and childbirth, and then weakening and thinning of the ligaments after the menopause due to lack of oestrogen can cause the uterus to lose its support and descend downwards into the vagina.
This can cause a sense of dragging discomfort, a feeling of the uterus falling out, or there can sometimes be a lump visible or able to be felt at the entrance of the vagina.
The type of prolapse depends on the area which is weakened and seen to be abnormal on examination. There can be isolated areas of prolapse, or multiple areas can be affected.
The various types of uterovaginal prolapse are as follows:
- A prolapse of the uterus is called a uterine prolapse.
- A prolapse of the front wall of the vagina, allowing the bladder to fall down also is called a Cystocele.
- A prolapse of the back wall of the vagina, allowing the bowel underlying the vagina to bulge upwards is called a Rectocele.
- A prolapse of the upper roof of the vagina is called a vault prolapse.
Symptoms
A prolapse of the uterus or vagina can cause a sense of dragging discomfort, a feeling of the uterus falling out, or there can sometimes be a lump visible or able to be felt at the entrance of the vagina.
Investigations
Diagnosis is mainly via history and examination. If there are symptoms suggestive of a bladder infection, (which prolapse increases the chances of), a midstream check of the urine for infection may be required. If there is any leaking of urine associated with the prolapse (urinary incontinence), this also may require some additional testing of the bladder also. Dr Friebe will discuss this if it is relevant.
Management
Management of a prolapse depends on symptoms. A lot of women may have some mild prolapse of the uterus and vagina on examination, but without any symptoms, it poses no threat or harm to the woman’s health.
Management can be either conservative or surgical.
Conservative management involves placing a small rubber ring, called a pessary, in the vagina to provide support to the uterus and vagina. This ring is usually changed over once or twice a year, and provides good support for many women who either wish to avoid surgery for their prolapse, or whose medical health is not suitable for a prolapse operation due to anaesthetic risk factors.
Surgical management is directed on providing definitive correction of the prolapse. The type of operation will depend on the type of prolapse that is present, and symptoms experienced.
See the lower section on prolapse surgery for a full explanation of surgical options.