What is it about ?
The pelvis is closed down by the perineum (pelvic floor), which is made up of three layers of muscles. The pelvic floor helps to keep the organs of the stomach in place. But, for various reasons, it can be damaged or become less flexible. This can cause the descent of one or more organs (prolapse). Genital prolapse refers to the descent of the uterus, bladder and / or intestines.
A classification can be made according to the severity of the prolapse:
- Grade I: the organ does not descend lower than the last third of the vagina;
- Grade II: the organ is visible in the genitals of the woman;
- Grade III: the organ clearly protrudes outwards;
- Grade IV: The organ, mainly the uterus, has completely slipped out of the vagina.
Where and how often?
One in 5 gynecological procedures is linked to this problem. Genital prolapse mainly affects women after menopause. The factors that promote organ descent are, among others, a full term pregnancy, pregnancy of twins, triplets, quadruplets,… (multiple pregnancy), chronic cough and constipation. A difficult or very rapid delivery can also damage connective tissue, which can cause prolapse.
In about 1 in 20 cases, prolapse is caused by a congenital weakness of the connective tissue and mostly affects young women.
How to recognize it?
At first, this is manifested by a feeling of heaviness in the lower abdomen, which usually gets worse in the evening and disappears when lying down. Sometimes you feel tension down or pain in your lower back.
At a more advanced stage, you may also have other problems:
- Problems when urinating: weak urine stream, feeling of not completely emptying the bladder, problem starting to urinate, having to urinate more often, seeking postures to urinate more easily, arriving too late to the toilet, not being able to urinate.
- Stool related problems: feeling of not emptying bowel, urgent need to have a bowel movement, painful or difficult stools, involuntary loss of stool, you have to use your finger to empty the bowel.
- Sexual problems.
How is the diagnosis made?
The doctor will ask you what your symptoms are, and he will examine you. He will ask you to increase the pressure in your stomach (for example by asking you to blow on your hand). He then watches what happens.
What can you do ?
Postnatal exercises are reimbursed. Enjoy it! You will learn to train your pelvic floor, which greatly decreases the risk of prolapse. Sufficient physical activity remains important after the postpartum period.
What can the doctor do?
In case of early stage prolapse, the following approach may help:
- Placement of a non-rigid synthetic ring (pessary) in the vagina to support weakened tissue.
- Local hormonal treatment stimulates blood circulation and relieves irritation of the mucous membrane.
- Strengthening the pelvic floor with the help of exercises under the supervision of a physiotherapist.
This treatment relieves symptoms and can sometimes prevent surgery.
If the prolapse is too advanced or the symptoms are too severe, surgery may be necessary. This is usually done through the vagina and less frequently through the tummy (through an endoscope (laparoscopy) or by opening the tummy (laparotomy). The procedure usually takes place when the woman is no longer planning a pregnancy.
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