Prolapse of the uterus and pelvic organs

What is pelvic organ prolapse

Pelvic organ prolapse is a downward descent of these abdominal organs such as bladder, uterus, intestines, rectum. It occurs when the muscles and ligaments of the pelvic floor, responsible for supporting the bowels, weaken and are no longer able to keep these organs in their correct position, which then slide downwards under the force of gravity.

Prolapse can cause pain and discomfort and impact your everyday quality of life. The answers of the midwife Monica Vitali, expert in dysfunctions and rehabilitation of the pelvic floor, to all doubts on the subject.

How do you know you have a prolapse?

Depending on the extent of the prolapse and the area involved, the woman may experience:

• a feeling of weight or bulk in the vaginal area or inside the pelvis, as if sitting on a ball; sometimes you just feel a mass protruding from the vaginal canal, or the sensation that something is blocked or is falling from the vagina;
• discomfort or pain during intercourse;
• urinary or fecal incontinence;
• intestinal disorders and gas leaks;
• difficulty in urination;
• discomfort or pain in the lower abdomen;
• backache;

Often the feeling of weight or protrusion becomes more pronounced towards the end of the day, after working or standing all day, while it lessens when lying in bed.

How many types of prolapse are there?

Generally when we talk about prolapse we think of the prolapse of the uterus, in reality the organs that can yield are different and there are different medical terms to indicate the disorder:

• hysterocele it is the prolapse of the uterus, which occurs when the uterus descends into the vagina;
• cystocele it is the prolapse of the bladder and occurs when the bladder, which collects urine, goes down and pushes against the anterior wall of the vagina;
• rectocele it is the prolapse of the rectum and occurs when the rectum protrudes into the posterior wall of the vagina;
• enterocele it is the prolapse of the small intestine and occurs when the small intestine falls between the posterior wall of the vagina and the rectum. Enterocele can occur along with prolapse of the uterus or rectum.

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How is the diagnosis made?

Prolapse is generally ascertained during a normal gynecological examination, first through a careful medical history of the woman, during which the doctor will inquire about the number and characteristics of the births, the presence or absence of menopause or any deficiency of estrogen hormones. Others will then be considered risk factors, such as obesity, chronic constipation or the presence of diseases that cause an increase in abdominal pressure or any surgery undergone in the pelvic area.

The presence of the prolapse is then confirmed with the visit, during which the doctor can ask the patient to assume the upright position, which can make the prolapse more evident thanks to the action exerted by the force of gravity; alternatively, a forced exhalation with closed glottis may be required: it is the so-called Valsalva maneuver, which, by causing an increase in intra-abdominal pressure, allows a better assessment of the prolapse.

If urination disorders are also present, it may be necessary to undergo one urological visit, or, in case of disorders in the posterior compartment (rectum or intestine) a proctological visit.

Read also: Endometriosis, the point about the disease

Why does prolapse come?

Prolapse of the pelvic organs occurs when the muscle structures of the pelvic floor they are elongated or not strong enough to support the organs in their correct position. Factors that can cause the pelvic muscles to stretch or weaken include:

• pregnancy and childbirth;
• age and menopause;
• obesity;
• fibroids or tumors of the pelvic area;
• chronic cough and chronic constipation;
• weightlifting;
• genetic conditions;
• previous pelvic surgery;
• some neurological conditions or spinal cord injuries.

Read also: Uterine polyps

How prolapse is treated

It essentially depends on the extent of the annoyance.
In the case of a minor prolapse - we speak of initial stage of I or II degree - different types of treatments can be used:

- Kegel exercises: I'm rehabilitation exercises which, through intermittent contractions of the perineum, help strengthen the pelvic floor muscles. In cases of mild uterine prolapse, these exercises may be the only treatment needed. To be effective, however, they should be carried out daily;

- Pvaginal discharge: it is a rubber or plastic device that is placed inside the vagina to support the pelvic floor and the prolapsed organ;

- Estrogen intake: is a testrogen-based drug therapy, which can help limit the weakening of the muscles and connective tissues that support the uterus, bladder and rectum. However, the possible drawbacks associated with the intake of this substance must be taken into account, such as the increased risk of clots, gallbladder disorders and breast cancer;

- Electrical stimulation and biofeedback: are two methods to be used in association. The first, by means of a probe inserted in the rectum or in the vagina, carries out a passive contraction of the pelvic muscles, while the second, through a video projection of the exercises to be performed, makes the woman exercise an active contraction of the same musculature;

- Radio frequency and electroporation: in both cases a probe is inserted into the vagina which, if radiofrequency is used, emits heat which stimulates the production of collagen and improves tone; with electroporation drugs, hormones or creams based on hyaluronic acid or vitamin E are conveyed directly into the vaginal mucosa, which nourish the tissues and prevent loss of tone.

When intervention is needed

If the prolapse is one advanced stage, grade III or IV, it is possible to rely on surgery. The methods are various and the choice depends on numerous factors, such as the type of prolapsed organ and the characteristics of the patient, such as age, the disorders that the prolapse causes, the possible presence of other pathologies of the pelvic district. In the case of uterine prolapse, for example, it will be evaluated whether to resort to hysteropexy, i.e. the suspension of the uterus, or hysterectomy, i.e. the removal of the uterus.

How prolapse is prevented

Some strategies help reduce the risk of prolapse. Here they are:

• consistently practice Kegel exercises that help strengthen the pelvic floor;
• reduce body weight in case of overweight;
• follow a balanced diet rich in fiber to avoid constipation;
• avoid making efforts that lead to a significant increase in intra-abdominal pressure, such as lifting excessive weights.

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• uterine prolapse
• uterus
• pelvic floor
• perineum
• muscle tone