A Gynecologist's Second Opinion:
The Questions & Answers You Need to Take Charge of Your Health
(Second Edition, Revised)
by William H. Parker
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  360 million women suffer from
some degree of prolapse in the United States and Western Europe alone
    Half of prolapse cases in the
United States are under age 60.
     

What is PELVIC ORGAN PROLAPSE?


Pelvic organ prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of prolapse in later life, but because many women don't seek help from their doctor the actual number of women affected by prolapse is unknown. Prolapse may also be called uterine prolapse, genital prolapse, uterovaginal prolapse, pelvic relaxation, pelvic floor dysfunction, urogenital prolapse or vaginal wall prolapse.
Pelvic organ prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. The womb (uterus) is the only organ that actually falls into the vagina. When the bladder and bowel slip out of place, they push up against the walls of the vagina. While prolapse is not considered a life threatening condition it may cause a great deal of discomfort and distress.
There are a number of different types of prolapse that can occur in a woman's pelvic area and these are divided into three categories according to the part of the vagina they affect: front wall, back wall, or top of the vagina. It is not uncommon to have more than one type of prolapse.

Prolapse of the anterior (front) vaginal wall

Cystocele (bladder prolapse)
When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall. It's common for both the bladder and the urethra (see below) to prolapse together. This is called a cystourethrocele and is the most common type of prolapse in women.
Urethrocele (prolapse of the urethra)
When the urethra (the tube that carries urine from the bladder) slips out of place, it also pushes against the front of the vaginal wall, but lower down, near the opening of the vagina. This usually happens together with a cystocele (see above).

Prolapse of the posterior (back) vaginal wall

Enterocele (prolapse of the small bowel)
Part of the small intestine that lies just behind the uterus (in a space called the pouch of Douglas) may slip down between the rectum and the back wall of the vagina. This often occurs at the same time as a rectocele or uterine prolapse (see below).
Rectocele (prolapse of the rectum or large bowel)
This occurs when the end of the large bowel (rectum) loses support and bulges into the back wall of the vagina. It is different from a rectal prolapse (when the rectum falls out of the anus).

Uterine and vaginal vault prolapse (apical or top)

Uterine prolapse
Uterine prolapse is when the womb drops down into the vagina. It is the second most common type of prolapse and is classified into three grades depending on how far the womb has fallen.
Grade 1: the uterus has dropped slightly. At this stage many women may not be aware they have a prolapse. It may not cause any symptoms and is usually diagnosed as a result of an examination for a separate health issue.
Grade 2: the uterus has dropped further into the vagina and the cervix (neck or tip of the womb) can be seen outside the vaginal opening.
Grade 3: most of the uterus has fallen through the vaginal opening. This is the most severe form of uterine prolapse and is also called procidentia.
Vaginal vault prolapse
The vaginal vault is the top of the vagina. It can only fall in on itself after a woman's womb has been removed (hysterectomy). Vault prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.


Causes of uterine and bladder prolapse


Risk factors

Normally, the pelvic organs are held in place by the pelvic floor muscles and supporting ligaments, but when the pelvic floor becomes stretched or weakened, they may become too slack to hold the organs in place. A number of different factors contribute to the weakening of pelvic muscles over time, but the most significant factors are thought to be:

  • Pregnancy and childbirth
  • Aging and the menopause
  • Obesity, large fibroids or tumors
  • Chronic coughing or strain
  • Heavy lifting
  • Genetic conditions (Marfan or Ehlers-Danlos syndrome)
  • Previous pelvic surgery
  • Spinal cord conditions and injury
  • Ethnicity (white and Hispanic women have the highest rate of pelvic organ prolapse, followed by Asian and black women)

Symptoms


  • Feeling a lump or heavy sensation in the vagina
  • Lower back pain that eases when you lie down
  • Pelvic pain or pressure
  • Pain or lack of sensation during sex
Women with mild prolapse may have no symptoms or discomfort at all and may not be aware they have a prolapse. When symptoms do occur, however, they tend to be related to the organ that has prolapsed.
A bladder or urethra prolapse may cause incontinence (leaking urine), frequent or urgent need to urinate or difficulty urinating.
A prolapse of the small or large bowel (rectum) may cause constipation or difficulty defecating. Some women may need to insert a finger in their vagina and push the bowel back into place in order to empty their bowels.
Women with uterine prolapse may feel a dragging or heaviness in their pelvic area, often described as feeling 'like my insides are falling out'. With severe prolapse, when the uterus is bulging out of the vagina, the skin may become irritated, raw and infected.

Diagnosis

If you have any of the symptoms of prolapse, particularly if you can see or feel something near or at the opening of your vagina, make an appointment to see your doctor. Many women with prolapse avoid going to the doctor because they are embarrassed or afraid of what the doctor might find, but prolapse is very common and is nothing to be ashamed of.
Before you see your doctor, it may help to make a list of symptoms, concerns and questions. Take the list with you to your appointment. It may be difficult at first to talk about your symptoms, and some women find the examination uncomfortable, but it only takes a few minutes and, by having your symptoms checked, you are taking an active role in your health and well-being.

Questions to ask your doctor about your prolapse


  • What type of prolapse do I have?
  • How severe is it?
  • Do I need treatment?
  • What treatment do you recommend and why?
  • What if I choose not to have any treatment?
  • What can I do to ease the symptoms?

An intimate examination can be unnerving and many women find it difficult to remember everything that is said during the appointment, particularly if the doctor uses technical terms. It may help to write down the answers to your questions. 

What to expect at your appointment

To look for signs of prolapse your doctor will need to do a thorough pelvic examination. You will be asked to undress from the waist down and lie on your back on the examination table. The doctor will ask you to bend your knees and let them fall open. Some women find this position difficult, so if you can't lie this way, say so. The doctor can do the examination with you lying on your side with your knees drawn up in the fetal position. In fact, many doctors will do this anyway when looking for prolapse as it's a good way to check the front and back walls of the vagina.
The doctor will feel for any unusual lumps or bumps in your pelvic area by inserting two fingers in your vagina and pushing gently on your abdomen. You will be asked if you feel any pain or discomfort. Tell the doctor if it hurts even if you are not asked. The doctor may also insert a special speculum (called a Sims speculum) to examine the walls of the vagina for bulges.
You may be asked to cough or strain during the examination. This enables the doctor to see if any urine leaks or if any of the pelvic organs prolapse into the vaginal walls. Some prolapse symptoms go away when you're lying down, so your doctor may also want to examine you while you're standing.
If you have bowel symptoms the doctor may need to feel for bowel prolapse by placing one finger in your rectum and another in your vagina and asking you to strain or bear down. If you have urinary symptoms, the doctor should take a urine sample to check for a urinary infection.
A good doctor will explain what s/he is doing throughout the examination but if you have any questions, ask for an explanation.

If you develop any of the following symptoms, call Dr. Taylor right away:


  • Any of the other symptoms mentioned above change or worsen
  • You have any unusual bleeding or discharge
  • Pain or discomfort is interfering with your daily activities sex becomes painful
  • You can feel or see something bulging out of your vagina or just inside your vagina

If you feel like you suffer from this and need expert opinion,
Click here for to arrange a Consultation with Dr. Lyndon Taylor


 
 
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