I get asked about prolapse A LOT. Most women are worried they are doing more damage by not ‘doing’ anything about it or that certain things could make it worse. Often, it doesn’t affect quality of life, in which case sometimes the best course of action is to ‘do nothing’- or a watch and wait approach, as it may worsen naturally with time and cause a nuisance.
What Is a Prolapse?
A prolapse refers to when pelvic organs, such as the bladder, rectum, or uterus, descend into the vaginal canal, often creating a “dragging” sensation or the feeling of something protruding- a ‘bulge’ down there. Common types include cystocele (bladder prolapse) and rectocele (rectal prolapse), and even after a hysterectomy, women can experience a vault prolapse where the top of the vagina sags down.
How is a prolapse diagnosed and assessed?
Assessing prolapse is a straightforward process that involves a speculum exam, similar to a smear test. By getting you to push or cough, I can observe the prolapse’s descent towards the vaginal opening and understand its where its coming from anatomically. While complex scoring systems exist, I focus on determining the type of prolapse you have, the health of your vaginal tissues, and recommending appropriate treatment options. If necessary, I can recommend you see a physiotherapist or gynaecologist for further treatment like supervised pelvic floor physio or corrective surgery, often known as a ‘repair’.
What Are My Treatment Options for Prolapse?
If you are diagnosed with a prolapse, there are several options:
- Do Nothing: If the prolapse isn’t bothersome, no treatment is necessary. A prolapse won’t worsen just because it’s untreated, though it may progress with age and certain activities of daily life- like heavy lifting or a bad cough!
- Pelvic Floor Exercises: A pelvic floor physiotherapist can help you with exercises that strengthen the muscles around the vagina to support the prolapse. This approach is most effective for milder cases.
- Pessaries: A pessary is a device inserted into the vagina to hold the prolapse in place. These come in various shapes and sizes, with options that are self-manageable and some that are compatible with intercourse. I’ll fit the pessary for you and recommend regular check-ups to ensure your vaginal health remains intact.
- IMPORTANT: Having a pessary fitted can often relieve the symptoms of prolapse, but can sometimes reveal bladder leakage- its a bit like having kinks in a hosepipe and then straightening them out.
- Surgery: If your prolapse is severe or your symptoms persist, surgery might be an option. A pessary trial is often recommended before committing to surgery to assess whether it will improve your symptoms.
Pessary Types Explained
Ring Pessary
The ring pessary is a simple and cost-effective option made from PVC or polythene. It’s ideal for bladder prolapse and can be worn long-term. You can have sex with them in, but some women feel funny about that. However, it needs replacing every six months to prevent vaginal erosion, especially in post-menopausal women. You can get this done at your GP surgery or return to me for a check-up.
Folding Ring Pessary
This type offers additional support for women experiencing stress urinary incontinence. These pessaries are more expensive (around £60) but are foldable, allowing you to manage them at home by taking them in and out as needed.
Cube Pessary
The cube pessary works by suction and is particularly effective for vault prolapse (after a hysterectomy) or severe cases involving the uterus or rectocele. It is self-manageable and should be removed at night, making it a great option for more advanced cases. They cost around £50 each and last up to 6 months.
How Can a Pessary Help with Prolapse?
Pessaries are designed to alleviate prolapse symptoms by providing physical support to the vaginal walls. Whether your prolapse affects the bladder, rectum, or uterus, these devices can be life-changing, improving both vaginal comfort and helping with urinary leakage.
If you’re interested in getting a prolapse assessed or trying a pessary, you can email me directly at drgillian@lincolnshirewomensclinic.co.uk or book an appointment.
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