Uterovaginal prolapse

Prolapse of the genital tract is a relatively common condition; in the United Kingdom, for instance, genital prolapse accounts for 20% of women on the waiting list for major gynaecological surgery. Prolapse can involve the uterus (womb), the vagina or, as is often the case, both. It can be looked upon as a type of hernia where structures around the vagina drop down because of a weakness or tears in the supporting tissues. Thus, weakness anterior to the vagina can lead to a urethrocele (prolapse of the urethra) or cystocele (prolapse of the bladder), weakness at the top to uterine or vault prolapse, and weakness posteriorly to an enterocele (prolapse of Pouch of Douglas) or rectocele (prolapse of the rectum). Of the different types of genital tract prolapse, prolapse of the bladder is the commonest.

The two main reasons for this weakness include vaginal delivery (childbirth) and the menopause, but other factors such obesity, a chronic cough or constipation, and in rare cases certain congenital conditions (something you are born with) or connective tissue disorders can also play a role.

Mild genital prolapse may be asymptomatic. Common symptoms include pelvic heaviness or a lump in the vagina. Depending on the site of the prolapse, some women develop urinary incontinence or a feeling of incomplete bladder emptying, others need to apply digital pressure to the perineum or posterior vaginal wall when opening their bowels. Prolapse can sometimes cause sexual difficulties.

Whilst a small prolapse can be managed with pelvic floor exercises, and pessaries (plastic device which is inserted into the vagina) can be considered, surgical repair is the only definitive treatment. Numerous procedures have been described over the year, but basically all aim to relieve symptoms and restore normal vaginal anatomy. Although surgery is usually done via the vagina, abdominal/laparoscopic procedures also have an established role in certain situations. Which type of operation is most appropriate depends on a number of factors, depending your history and the nature of your prolapse. Unfortunately, it is recognised that a significant number of women will require reoperation at some time after surgery.