Vaginal deliveries of large children, especially when forceps or ventouse were used to assist delivery, and women who strain repeatedly to empty bowels, are more likely to develop uterovaginal prolapse.
Some women have different collagen which results in an increased tendency to weakened support – this occurs in women who have hypermobility syndrome.
Everything changes shape as we get older, including the pelvic floor, but if the changes do not allow a normal life then it is sensible to see if there are any measures to help.
There is no direct relationship between uterus/vaginal prolapse, and the symptoms you have. Prolapse itself can cause a dragging feeling with standing. Bladder control, and or difficulty emptying the bladder are common problems.
Difficulty opening bowels, having to use finger pressure on the perineum/vagina/anal canal are also needed sometimes. Intercourse may be uncomfortable especially if the vagina has low levels of oestrogen after the menopause. Vaginal dryness will usually respond to local oestrogen treatment.
Lifestyle – Alter your diet and fluids to avoid constipation, and it is a good idea to avoid drinking later than three hours before going to bed to reduce the need to go to the bathroom overnight. Make sure your bladder is as empty as possible by double voiding – take time to allow a second flow of urine.
Pelvic floor exercises – With the help of a specialist nurse/physiotherapist with skills in pelvic floor techniques and exercises, it is possible to improve the symptoms. Techniques include measuring the strength of muscles, electrical stimulation and the use of pelvic floor cones (weight training).
Vaginal pessary – It is almost always possible to find a vaginal pessary to support the prolapse. Some of the pessaries can be self-managed, and some need review once or twice a year. There are very few side effects, and if we find the right one, you should be able to forget about it. There are many pessaries to try, and we don’t always find the correct one for you at the first visit.
Using a pessary can be a long term option allowing you to lead a normal life.
Unfortunately there is no perfect operation which resolves prolapse without recurrence, gives good bladder/bowel function, and normal intercourse. For example, of the women with prolapse who undergo surgery who are not leaking urine before surgery, 10-15% will start leaking with coughing or exercise after surgery.
It is not a case “of a stitch in time …” . It is possible to do vaginal operations under spinal anaesthetic at any age.
Because there is no perfect operation, many different procedures have been tried for pelvic floor repair. The most frequent operation carried out in the UK is vaginal hysterectomy and repair – but this has a higher chance of recurrence than procedures which do not include a hysterectomy. The surgery I use does not need a hysterectomy and does not use mesh (Manchester repair) – it is proving very successful and I teach this technique to trainees and consultants.
No – surgery today, cannot prevent problems later in life. Pelvic floor repair can be done using a spinal anaesthetic safely well into 90s
No – the opposite is true. If you remove the uterus, the incidence of recurrent prolapse of the top of the vagina (“vault” prolapse), is up to seven times higher over the next 5 yrs.
No – many women use a pessary successfully for years – there are more than 15 types available, and many can be self-managed.