Prolapse is a downward displacement of one of the pelvic organs from its normal position. It usually involves the uterus and along with it may be bladder or rectum. Prolapse is most often attributed to childbirth injury or it may be due to the inherent weakness of suspensory ligaments. Prolapse manifests most commonly after menopause when the ovarian hormone production stops and genital support weakens due to lack of hormone estrogen.
Signs & Symptoms
- Patient feels a lump coming out of introitus.
- Dragging pelvic sensation especially at end of day.
- Difficulty in walking, difficulty in intercourse.
- Concomitant stress incontinence or frequency, inadequate emptying of bladder, repeated urinary tract infection.
- Difficulty in defecation & constipation.
- Clinical examinations.
- Ultrasound – Pelvis – Done to rule out any coexistent pathology.
- Expectant Management: Prolapse may be discovered during a routine gynecological examination. Such patients may not have any symptoms. They are advised for buttock squeezing exercises or Kegels exercises. In postmenopausal women use of estrogen cream may help strengthen the supports.
- Surgical Management: The nature of the surgery depends on degree & type of prolapse, the need for preservation of menstrual, reproductive, or coital function. The operations can be done vaginally, abdominally or laparoscopically.
- Vaginal Hysterectomy and Repair: Uterine prolapse is generally treated by vaginal hysterectomy and repair. It is preferred in a woman who has the desired number of children and is not particular about preserving menstrual function. The advantage is that both anterior and posterior repair can be done in the same sitting without the need for a separate incision or for repositioning the patient.
- Manchester/Fothergill Repair: This is an alternative for patients with prolapse who wish to retain the uterus. The ligaments are repositioned to provide adequate support to the uterus.
- Utero/Cervicopexy & Sling Operation: Occasionally marked uterine prolapse may develop in a young patient due to the inherent weakness of suspensory supports. The basic principle behind these operations is to fortify the supporting ligament structures. Either natural body tissue may be used such as rectus sheath or artificial material such as mersilene/nylon tapes may be used. This operation is now also possible laparoscopically.
- Le FortRepair: Reserved for very elderly women who do not wish to retain coital function.