Prolapse

Prolapse is the situation where there is weakness of the supporting tissues of the uterus or the vaginal walls, so that the organs bulge or sag into the vagina. The uterus may descend so that the cervix is visible at the entrance to the vagina. The front wall of the vagina may bulge downwards - since this is also the back wall of the bladder it is called a cystocoele. It may either cause incomplete emptying of the bladder or stress incontinence, when there is urinary leakage on coughing or sneezing. The back wall of the vagina may bulge upwards - since this is also the front wall of the rectum it is called a rectocoele. It may interfere with defecation, with a persistent sensation of incomplete evacuation of the bowels.

Prolapse, cystocoele and rectocoele are usually a consequence of muscular damage which occurs during pregnancy and childbirth, and a reduction in muscular tone as we age. Vigorous pelvic floor exercises in the postnatal period may be helpful in the future, and physiotherapy can increase muscle tone. If uterine prolapse is troublesome (and mild degrees of uterine descent into the vagina may not be noticed) then it may be possible to hold it in place by using a ring pessary. It is necessary that these are changed regularly. More severe degrees of prolapse will require surgery, as may cysctocoeles and rectocoeles.
 
 
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