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Pelvic Floor Prolapse

Is extremely common and results usually after pelvic floor damage from childbirth. It can however also occur in women who have never had children. Women usually start to experience symptom in their 30’s or 40’s and these usually often become much more pronounced with increasing age. Symptoms may be associated with urinary or bowel symptoms also. Prolapse
Is usually divided into three types depending on which part of the vaginal is affected. Any combination of below is possible.

1. Anterior compartment prolapse, involving loss off support around the bladder (cystocoele).
2. Posterior compartment prolapse, loss of support between the rectum and the vagina (rectocoele).
3. Middle compartment prolapse, loss of support at the top or apex of the vagina (utero-vaginal prolapse)

Symptoms include;

Pressure in the vaginal
A feeling of something coming down
Discomfort during intercourse
Urinary urgency, frequency or incontinence
Difficulty passing a bowel motion.

It can be found coincidently when a women attends her GP for a smear and if this is observed or commented on by the GP, the women often completely unaware (asymptomatic).
Sometimes women will see prolapse during self-examination where they can see what a lump “egg” protruding though the vaginal. In very severe cases the whole uterus/vaginal (If they have had a previous hysterectomy) can prolapse outside the vagina “procidentia” / “vaginal vault prolapse”.

Treatment options depend on how much it is affecting a women’s quality of life, and are:

1. Simple reassurance and observation if symptoms are not to troubling (the prolapse may not worsen with time).
2. Pelvic floor physiotherapy, pelvic floor exercises.
3. Vaginal oestrogen treatment.
4. Vaginal support pessaries.
5. Surgery (this is successful in 2 out 3 women and about 1/3 will require a further repair in their lifetime.