Pelvic floor weakness and prolapse are common gynaecological conditions. The presence of prolapse is related to the muscles surrounding the vagina and the supporting structures for the pelvic organs (the bladder, womb, and the bowel). Normally, the pelvic organs are held up by a collection of interrelated muscles, strong fibrous tissue and ligaments, rather like a strong hammock. These supporting muscles and ligaments may weaken with time, pregnancy and childbirth, chronic straining, heavy lifting, and result in prolapse. Again, rather like someone heavy suddenly sitting in a soft hammock, the pelvic organs may begin to sink into the weakened vaginal muscles, and cause a bulge or lump in the vagina which is often felt as something bearing down, or may even be a visible lump. Some women will also complain of vaginal laxity or an inability to squeeze their pelvic floor / vaginal muscles.
It is important to remember that many women will have a certain degree of prolapse, and the decision for treatment is very much dependent on the impact that your symptoms have on your quality of life. There are a range of non-surgical and surgical treatments, and the choice will depend on your wishes, and your medical and surgical history. If you have associated problems with your bowel and/or bladder you may require additional specialist tests such as an MRI (a special scan) or urodynamics.
Some women will choose to have conservative treatments and we have a range of different treatments. These encompass vaginal pessaries and special pelvic floor exercises amongst others. Many women will opt to have surgical treatment for their prolapse. Dependent on the type and amount of prolapse present, surgery may be vaginal or abdominal (generally using keyhole laparoscopic surgery). Due to the fact that prolapse is often a result of underlying weak muscle and tissue, although surgery may restore anatomy, prolapse can return. To try and minimise this we may use special reinforced stitches and material (“mesh”) to treat your prolapse. To appropriately treat their prolapse, some women may wish or require to have a hysterectomy, although we have also developed innovative techniques that mean that women even with very advanced prolapse can avoid having a hysterectomy.