Genital prolapse, better known as organ prolapse, is a taboo subject for many women. However, solutions exist to avoid and treat genital prolapse. Perennial rehabilitation, pessary installation, surgery intervention. etc. discover all the treatments available to compensate for organ descent
What is genital prolapse? Is My Life Over With Prolapse?
Genital or genitourinary prolapse only concerns women since it involves slippage of the pelvic organs into the vagina or outside the vulva. There is a name for prolapse for each organ affected (even if several genital organs) can be affected at the same time:
- bladder prolapse or cystocele
- Uterine prolapse (womb) or hysterocele.
- Rectal prolapse or rectocele
- Small intestine prolapse or enterocele
- Prolapse of the urethra or urethrocele
- Vagina or apical prolapse
Genital prolapse is a common but benign pathology in women. On average, 40% of women over 45 have a more or less significant prolapse.
Only 10% of affected women have to undergo surgery Contrary to popular belief, prolapse is not only a disease linked to age and pregnancy.
What causes genital prolapse
To understand the causes of genital prolapse, let us start with some basic anatomy. The pelvic organs are fixed independently by a double anchoring system. The ligament that connects the organs to the bones of the pelvis.
The pelvic floor (perineum ) supports all of the pelvic organs. For this system to work, the pelvic floor muscles and ligaments must be toned. Weakness or muscle relaxation is enough to cause the pelvic organs to descend. Organ descent goes through several stages initially, the organs press on the vagina wall. Little by little, it deforms under the weight. The organs then end up passing the vulva orifice and exiting outside the vagina.
Genital prolapse risk factors what are they
Several risk factors can promote the descent of the pelvic organs.
Repeated pregnancy and difficult natural deliveries.
- The use of forceps.
- A Tear in the perineum or even a high weight of the newborn
- The natural aging of the body which causes ligament and muscle relaxation
- Estrogen deficiency after menopause
- Obesity
- Overweight and a sedentary lifestyle
- A surgical procedure such as a hysterectomy where the pelvic organs will have been affected
- Practicing and intensive sporting activity
- Repeatedly carrying heavy loads
- A chronic cough or constipation
- More rarely, an abnormality of the spine and pelvis or abnormalities of muscle tissue that reduce the elasticity of muscles and ligaments
What symptoms to look out for
Most genitourinary prolapse goes unnoticed. Patients often discover by chance that one or more of their organs are descending. Usually during a gynecological examination.
When Symptoms are present, they are characterized by a feeling of heaviness in the vagina. Like a lump in the vagina that weighs and causes discomfort. This feeling of discomfort generally increases when standing and at the end of the day.
Associated symptoms can also alert the patient such as urinary problems (urinary leaks, recurrent infections, difficulty urinating, etc) anorectal problems (constipation or anal incontinence), or even sexual problems (pain during sexual intercourse).
Although benign, genital prolapse can cause complications, especially in cases of externalized prolapse (when the organ is outside the vulva) furthermore, organ descent can have repercussions on your daily life: discomfort during physical activities or sexual relations, impact on social relationships which can lead to isolation and discomfort, even depression. If you think you have genital prolapse, do not hesitate to consult your doctor or gynecologist if the Symptoms are severe.
Genitourinary prolapse: which treatment to choose?
Treatment for genital prolapse: Several treatments are possible, so-called conservative treatments in cases of moderate products and surgical treatment as a last resort. The doctor explains to his patient the different treatments, their advantages, and the risk of complications. The choice of treatment is made in consultation with the patient. This is a shared medical decision
The therapeutic plan depends on the importance of the genital prolapse, the age of the patient, and the complaints she expresses
✔️Conservative treatment
As a general rule, the conservative treatment offered is always associated with hygienic and dietary measures. Hygiene dietary measures help reduce the impact of a prolapse and prevent recurrences. The main ones are:
- Choose a healthy balanced diet and lose weight
- Practice physical activities to avoid a sedentary lifestyle
- Learn to better carry heavy loads
- Treat chronic constipation and better manage efforts to go to the toilet
- Control your cough
- Pelvic floor strengthening exercises are also prescribed by a midwife or physiotherapist.
- Perennial rehabilitation, also prescribed after childbirth, aims to strengthen the pelvic muscle and delay the descent of organs.
Finally, the use of a pessary can complement rehabilitation. The pessary is a vaginal device which, once placed deep in the vagina, helps hold the organs in place.
✔️ Surgery treatment
Surgical intervention is offered as a last intention. Often after failure of rehabilitation or when the prolapse is very significant. Several operating techniques are possible.
Abdominal surgery: the procedure consists of correctly repositioning the organs in the small pelvis and holding them in place using strips and reinforcing implants.
Vagina surgery: here the surgeon sutures the ligament and muscles of the pelvis, without using a prosthesis or stripes.
Still, virginally, another technique consists of permanently closing the vagina. This last technique is often offered to elderly women. It is a minimally invasive operation perfect for the most fragile people. On the other hand, the patient must realize that the vagina being closed, vagina penetration is no longer possible.
Genitourinary prolapse can be treated in various ways: better lifestyle, perennial rehabilitation, wearing a pessary, surgical intervention, etc. Monitoring the progress of the prolapse is necessary.
Conclusion
Conservative measures are sufficient if the symptoms are mild or in the event of a surgical contraindication. The patient is regularly signed in consultation for monitoring. The progression of prolapse is slow over time.
Surgery is useful when the discomfort caused by genitourinary prolapse is significant or if conservative treatment (hygiene dietary measures, rehabilitation, and pessary) is not sufficient. It allows the pelvic organs to be repositioned to eliminate symptoms and discomfort.
References
- Friedman T, Eslick GD, Dietz HP. Risk factors for prolapse recurrence: systematic review and meta-analysis. (https://pubmed.ncbi.nlm.nih.gov/28921033/) Int Urogynecol J. 2018;29(1):13-21. Accessed 8/22/2022.
- Kudish BI, Iglesia CB, Gutman RE, et al. Risk factors for prolapse development in white, black, and Hispanic women. (https://pubmed.ncbi.nlm.nih.gov/22453694/) Female Pelvic Med Reconstr Surg. 2011;17(2):80-90. Accessed 8/22/2022.
