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Written by: Kathryn Danzey

Prolapse of the womb or part of the womb is a very common condition, especially as women get older.

What exactly is a prolapse?

Prolapse simply means “something coming down” and usually refers to either the womb (uterus) coming down into or through the vagina or the vaginal walls themselves bulging down.

Types of prolapse

1. Uterus

2. Vaginal wall which could be front wall, adjacent to bladder when it is called a cystocele back wall, adjacent to rectum when it is called a rectocele, or small bowel when it is called an enterocele

3. Vault prolapse. It is also possible to have a prolapse of the top end (vault) of the vagina after having had a hysterectomy.

Why does it happen?
The womb is held up by several muscles and ligaments which support it between the bladder and the back passage (rectum) and are referred to as the pelvic floor. When these ligaments and muscles become lax and over-stretched the womb and vagina begin to prolapse downwards as they are no longer well supported.

What problems does a prolapse cause?

Sometimes prolapse doesn’t cause any problems at all but usually the most common symptoms is a feeling of a lump or a bulge outside the vagina. It is usually painless but gets worse on standing or straining and towards the end of the day. It usually disappears on lying down. Other symptoms will depend on exactly where the prolapse is.

For instance, if the prolapse is in the front wall of the vagina (cystocele), the bladder will prolapse down and you may have difficulty in passing water or find yourself going to the toilet frequently. You may also keep getting cystitis. Also you may experience some leakage of urine when coughing or straining (a phenomenon called stress incontinence).

When the back wall of the vagina prolapses (rectocele) it can cause a dragging pain and low backache. This may also cause you to have a problem opening your bowels and sometimes women have to push the prolapse back with their finger in order to be able to have a bowel motion. You may also suffer with constipation.

What is the treatment for prolapse?

Treatment will depend on how severe the prolapse is. If your symptoms are only slight, the following advice may be helpful:

1. Weight loss: if you are overweight

2. Pelvic floor exercises: this may strengthen the pelvic floor muscles, provided you do it regularly. You may be referred to a physiotherapist for more detailed advice.

3. Hormone replacement therapy: this may be in the form of tablets, patches or creams/pessary inserted vaginally. This helps the vaginal skin to maintain its elasticity.

4. Avoid constipation and undue straining: having a healthy diet with plenty of fibre or occasional use of a mild laxative will also help.

If the prolapse is more severe, you will need either a pessary to support the tissue or a repair operation.

Pessary treatment

For anyone who prefers not to have an operation, a non-irritant vinyl ring pessary may be inserted into the top of the vagina to hold up the prolapse. Sometimes it takes more than one attempt to get the correct size (rather like fitting shoes!!). Once in place it cannot be felt and can be safely left for four months before it is taken out for cleaning, the vaginal skin checked, then the ring is replaced.

It is possible to have sexual intercourse with a ring in place, although your husband or partner may be aware of it?

Occasionally, a ring pessary can cause soreness of the vaginal wall and if this happens or if you experience bleeding or discharge the pessary will need to be removed and the vaginal wall inspected to ensure there is no infection or ulceration.

Very occasionally, if a ring pessary won’t stay in place a shelf pessary is used, but this is usually in older women who no longer have sexual intercourse.

A ring pessary may also be used in women experiencing prolapse during pregnancy or immediately after childbirth. The use of a ring pessary does not cure a prolapse, it only relieves symptoms.

Prolapse repair operation

There are several variations and combinations of prolapse repair operation, depending on what type of prolapse is present.

cystocele repair – if the prolapse involves the front wall of the vagina

rectocele repair – if the prolapse involves the back wall of the vagina. In this situation additional repair of the perineum is often performed at the same time especially if it is deficient

vaginal hysterectomy – if the prolapse involves the uterus

enterocele repair – if the prolapse involves the top of the vagina

A repair operation may involve any combination of the above four categories.

The basic principle of the surgery is to remove excessive skin of the sagging wall of the vagina, insert sutures to tighten the tissue and to attach the tissue to strong ligaments for support.

Is the surgery always successful?

Not quite. Whilst the surgery is almost always successful initially, in some cases, the prolapse may recur after some time. The main reason is that tissue, once stretched and weakened may give way again gradually, with time.

Another explanation for “recurrence” is prolapse of a different part of the vagina. For example, prolapse of the back wall of the vagina may occur some time after repair operation for the front wall.

To avoid recurrence:

1. Continue to do regular pelvic floor exercises after surgery

2. Avoid constipation

3. Consider the use of HRT

Recurrent prolapse

In this situation, a special approach is required. There are two different methods:

1. Vaginal approach
The operation is called sacrospinous fixation – because it utilises the strong sacrospinous ligament to support the top of the vagina.

2. Abdominal approach
The operation is called sacrocolpopexy which involves a synthetic tissue graft material to support the top of the vagina to the ligament of the sacrum.

Will the repair operation affect sexual intercourse?

In general, the repair operation should not cause problem with sexual intercourse. It may, on the other hand, tighten the vagina and improve sensation. Rarely, a tight repair may be considered in women with recurrent prolapse or who has ceased to have sexual intercourse. In this situation, the tight repair would ensure good support and reduce the risk of recurrence of prolapse, but the vagina may be significantly narrowed so that sexual intercourse may be uncomfortable or not possible.

What about convalescence?

Weeks 1-2

For two weeks after leaving hospital you should convalesce. Convalescence means plenty of rest: out of bed late, into bed early, with a rest in the afternoon. Only very light housework should be attempted. If you do too much too soon you will feel tired very quickly. Build up gradually and only do a little more each day.

Weeks 3-4

In the following two weeks you can begin to do more but avoid heavy shopping, lifting furniture, hoovering and energetic sports. Short walks are good exercises to start with. Try sitting rather than standing while you are doing some work.

Weeks 5-6

You may resume swimming. You may drive a car for short journeys but do not attempt too much – it takes several weeks after an operation for concentration and reflexes to return to normal. It is also advisable to check with your insurance company regarding this.

Weeks 6-12

After 6-8 weeks some women are fit for work, but this is very much an individual thing and depends on your rate of recovery, type of job, distance travelling etc. Women in heavier jobs often need up to 3 months off work.

Be sensible, build up gradually and don’t hesitate to seek advice if you are unsure about any activities. Well meaning relatives, friends or even patients may tell you things that are alarming or even inaccurate.

What else do I need to know about the repair operation?

1. Catheter:

After the operation, you will have a catheter left in the bladder for approximately four days. After the catheter is removed, very occasionally, there may be difficulty in emptying the bladder, or emptying it completely. The nursing staff will ask you to keep a record of how often you pass urine and how much you pass on each occasion (fluid output chart). Depending on the results, it may be necessary to re-insert the catheter to find out if the bladder is working normally. If so, the catheter may be removed immediately; if not, the catheter will need to stay in for a few more days.

2. Cystitis:

This is one of the commonest problem after repair operation, especially cystocele repair. It may occur after the catheter has been removed. The usual symptoms are: frequency and pain with passing urine. The treatment is simple – a course of antibiotics.

3. Perineal discomfort:
After repair, especially repair of the back wall of the vagina (rectocele repair), the sutures in the perineum may irritate the skin and cause discomfort for a week or two. It may be difficult to find a comfortable sitting position. Sutures in the perineum may be removed around the sixth post-operative day, especially if they irritate you; however, they may also be left to be absorbed gradually over a period of four weeks or so.

When should I consult my GP/consultant (after discharge from hospital)?

You should have been given an appointment to see Mr Li for a routine check up about six weeks after the operation.

However, you should contact Mr Li or your GP if you experience the following:

offensive vaginal discharge

significant vaginal bleeding i.e. more than a period

persistent pain in vagina or perineum or lower abdomen


Prof T C Li

Consultant Gynaecologist

7 Williamson Road

Sheffield S119AR

Tel: 0114 2550365

March 2007

About the Author

Kathryn Danzey
I have a passion to bring to you what really works in the beauty industry, from a moisturiser to the latest advanced treatment for anti ageing. After almost 4 decades in the industry I'm packed with info to share but never tire of looking for new things and would love you to share your experiences with us too. We're here to help you find that treatment or product that will make a change for you. Can't do without My Collagen Shots and H3O Night Repair. Love a great serum and UV protection

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