Introduction
This is a very common problem in women which tends to start at the fifth decade of their life. It is caused, among others, by vaginal delivery, during which muscles, connective tissues and ligaments that support the pelvic floor, the vagina and the uterus, are damaged.
Consequently, various organs (bladder, intestine, colon) protrude through the vaginal wall, a condition very similar to hernia. In addition, weakness of the supporting ligaments might even cause prolapsed uterus to protrude out of the vaginal opening.
Symptoms
The symptoms include organs protruding through the vaginal opening, difficulty to empty the bladder, urination frequency and urgency, urine incontinence, constipation and leakage of feces.
Diagnosis
Gynecological examination by a physician specialized in pelvic reconstruction surgery.
Treatment
Treatment is conservative and surgical.
Conservative treatment
Conservative treatment comprises vaginal supporters (pessary) and physiotherapy. Vaginal supporters are rubber or silicon devices, in various size and shape that support the vaginal wall and the uterus (figure 1).
Pelvic floor rehabitilation physiotherapy that usually employs training pelvic floor muscles and biofeedback, might sometimes help to ease symptoms by strengthening the vaginal entrance muscles. However, this option is effective only when the prolapse is slight or medium.
Surgical treatment
Comprises of correcting and fixation of the vaginal walls and dome, usually via vaginal approach, but it can also be done by laparoscopy or an abdominal approach.
It is possible to incorporate biological or synthetic implants which improve success rates of these operations, especially after failure of a previous surgery. Sometimes there is a need to correct stress urinary incontinence as well. In such cases, a combined surgery which handles both problems is performed.
Figure 1: Vaginal pessaries