A Prolapse is a medical condition where an organ or tissue falls down or slips from its normal position. A pelvic organ prolapse is a condition that occurs when the structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself fallsout from their normal position.

Utero-vaginal prolapse is a downward movement of the uterus and/or vagina. The main cause of the prolapse is the weakness in the supporting tissues of the uterus and vagina. The common factors such as frequent lifting of heavy objects, chronic cough, severe constipation, menopause, childbirth, and pregnancy may increase your risk of developing utero-vaginal prolapse.

Symptoms

A woman with a mild prolapse may not experience any symptoms. However, women with more severe forms of prolapse may experience

• Sensation of pulling in the lower abdomen or pelvis
• An uncomfortable feeling of fullness in the vagina
• Low back pain
• Urinary problems, such as urine leakage or urine retention
• Difficulty in urinating and emptying bowel
• Vaginal bleeding or discharge

Diagnosis

Your doctor will diagnose the condition by taking a detailed history and performing a physical examination. During the examination, you may be asked to cough or bear down. The doctor may also perform computerised testing of the bladder to test for urinary leakage.

Treatment

If the symptoms are mild, non-surgical treatment options such as medications, pelvic floor exercises, vaginal pessary (a device that is inserted into the vagina to support the pelvic floor), estrogen containing vaginal cream, and lifestyle changes may be helpful.

Surgery can be considered in patients with severe symptoms of utero-vaginal prolapse. There are different types of procedures to address the prolapse, such as hysterectomy (removal of the uterus), hitching up the bladder or vagina, or repair and ‘tightening’ of the vagina. The surgery may be done through an incision in either the abdomen or the vagina, depending upon the condition. The aim of the surgery is to restore normal anatomy and function of the pelvic organs.

Complications

If left untreated, severe cases of utero-vaginal prolapse can cause ulceration and infection of the cervix and vaginal walls, urinary tract infections, lower tract bleeding, thickening of the skin of the cervix, urinary obstruction, and worsening of the prolapse.

Prevention

Although utero-vaginal prolapse is not always preventable, there are certain measures that can be taken to help reduce the risk of developing utero-vaginal prolapse or prevent it from getting worse. These include

• Perform Kegel exercises to strengthen your pelvic floor muscles especially during pregnancy and after childbirth
• Do not bear down when giving birth until your cervix is completely dilated
• Take hormone replacement therapy after menopause
• Avoid constipation and straining with bowel movements, after delivery
• Avoid heavy lifting, prolonged standing, and chronic cough
• Perform pelvic floor exercises on a regular basis