Uterine prolapse

The prolapse of an organ is the descent of its usual position. In the case of genital prolapse, it occurs due to a weakness in the pelvic floor muscles, which causes the organs adjacent to the vagina to protrude through the vagina. The pelvic floor is the name given to the muscles and ligaments that support and maintain the organs of the pelvis, the uterus, the urinary bladder, the rectum and the intestines, basically in their position.

Genital prolapse can be divided into three different types:

• Anterior prolapse (cystocele or urethrocele): the bladder, urethra, or both organs press on the front of the vagina.
• Median prolapse (uterine or vaginal dome prolapse): The uterus, or the dome of the vagina in patients who have had the uterus removed, protrudes into the vagina.
• Posterior prolapse (rectocele or enterocele): the rectum or the intestines press on the back of the vagina, the rectum does so in its outer half and the intestines can do so in the upper half of the vagina.

Symptoms

The most frequent symptom is the sensation of pressure or heaviness in the lower abdomen or directly in the vagina. It is also the cause of:

• Appearance of a lump in the vagina or through the lips.
• Difficult or painful sexual intercourse.
• Lower back discomfort.
• Alterations in urination: urine leaks, frequent urinary infections, difficulty in completely emptying the bladder ...
• Difficulty in defecation, feeling of not emptying the rectum correctly.
• due to damage to the mucous membranes from rubbing against clothing when protruding out of the vaginal opening.

Causes

The most common cause of genital prolapse is obstetric trauma from vaginal deliveries, especially in large babies. It is also produced by other causes:

• Women with looser tissues and weaker pelvic muscles tend to have more uterine prolapse.
• The lack of estrogens produces a weakness in the mucous membranes and the tissues of the pelvic floor, favoring prolapse.
• The chronic increase in pressure in the pelvic floor produced by being overweight, by chronic cough, physical activity with strong impact or the continuous excessive weight bearing produce weakness of the pelvic floor tissues and a higher incidence of prolapse.

Diagnosis

The diagnosis of a prolapse does not require any imaging test, simply an examination in consultation in which the specialist doctor will assess the degree of descent of the pelvic organs and, if it is an anterior, posterior, uterine or total prolapse.

Treatment

Treatment depends on the discomfort the woman has. Some women do not feel any discomfort or their quality of life does not diminish despite having a significant prolapse and then it is possible to do an expectant behavior and see its evolution.

Above all, emphasis should be placed on a change in some lifestyles, such as losing weight in overweight women, avoiding chronic cough in smokers ... which would improve the symptoms of a prolapse.

In some cases, a vaginal pessary (a plastic ring that is inserted into the vagina and holds the uterus in place) may be placed. With this device, surgery can be avoided, especially in women at high surgical risk. Some women report a foul-smelling discharge or pain from the introduction of the pessary.

Surgery is the treatment in the most advanced cases. There are different surgical techniques to be able to adapt the best treatment to each woman, some of them are performed from the abdomen generally using the laparoscopic route and others are performed vaginally. On some occasions it is necessary to place meshes to help support the tissues.

Prevention

Physical therapy with Kegel exercises strengthens the pelvic floor muscles, making it difficult for the pelvic organs to descend. These exercises are usually started with a specialized physiotherapist but can be followed at home.

In some women, the specialist doctor will indicate a treatment with estrogens topically to improve or prevent tissue atrophy and make the appearance of prolapses more difficult.

• The most frequent symptom is the sensation of pressure or heaviness in the lower abdomen or directly in the vagina.
• Physical therapy with Kegel exercises strengthens the pelvic floor muscles, making it difficult for the pelvic organs to descend.
• MAPFRE makes the Family Medical Guidance Service available to its insured, which provides free 24-hour telephone access to specialists to resolve health-related questions.