What is genital prolapse?
Genital prolapse refers to the descent of the pelvic organs through the vaginal canal. To better understand how it happens, it is useful to frame the functioning of the pelvic floor
The pelvic floor is the set of muscles, ligaments and connective tissue that forms the support of all the organs of the pelvic region, i.e. the uterus, bladder, intestine and urethra (in the case of female subjects).
For some reasons – which we will see later – it can happen that the floor weakens or is injured: this will cause an impairment of its support function and the prolapse of the pelvic organs, defined as genital prolapse.
In this case it will therefore be possible for example for the uterus to slide downwards, until it protrudes inside the vagina or even outside the external vaginal orifice (uterine prolapse).
Although prolapse can occur in women of any age, women in menopause and those who have had multiple natural births are most affected.
Different degrees of severity of vaginal prolapse
The most commonly used method today to measure the severity of vaginal prolapse is the POP-Q system (Pelvic Organ Prolapse – Quantification) which is based on well-defined anatomical landmarks in order to standardize clinical findings.
Therefore, they identify:
Stage 0: represents a normal condition, when there is no prolapse.
Stage 1, mild prolapse: The protrusion is a cm or more away from the hymen.
Stage 2: The prolapse is approximately at the level of the hymen, between one cm above and one cm below.
Stage 3, the prolapse is moderate: the protrusion is lower than one cm from the hymen but is shorter than the total length of the canal and could reach the opening of the vagina.
Stage 4, there is an outflow of the organ from the vagina.
Causes of prolapse
Among the causes of genital prolapse are all those responsible for a weakening of the pelvic floor structures.
Between these:
- Aging and menopause, during which the production of estrogens, responsible for the tonicity of the pelvic floor, is reduced
- Natural birth: especially in the case of multiparous women or large newborns
- Overweight or Obesity
- Constipation
- Chronic bronchitis
- Lifting heavy weights incorrectly
- Congenital diseases: eg collagen diseases
Symptoms and complications
The symptoms are different depending on the severity of the prolapse.
In milder cases, patients may be asymptomatic.
In the case of moderate or severe prolapse, however, symptoms may begin to appear, such as a feeling of pressure or fullness in the vagina or the perception of organ leakage in the most severe cases.
In fact, cystocele (or bladder prolapse) or rectocele (prolapse of the last part of the intestine) can be observed.
In terms of symptoms, many women complain of pain during sexual intercourse or urinary disorders, such as urinary incontinence or the inability to completely empty the bladder.
This could predispose you to recurring urinary tract infections.
In the case of prolapse in the last stages, the vaginal mucosa can become dry, inflamed, thickened and exposed to infections, up to the formation of real ulcers responsible for pain and bleeding.
Correct gynecological follow-up is strongly recommended in these cases, both for diagnosis and for treatment and evaluation of complications.
The diagnosis of genital prolapse is based on
- Pelvic exam. A vaginal examination with a speculum is usually sufficient to diagnose a prolapse. Also during the visit, the gynecologist could make the patient contract the pelvic muscles to evaluate the muscle strength and a possible weakening of the pelvic floor.
- Evaluation questionnaire, in which the doctor will interview the patient to ask about the symptoms and discomforts experienced in everyday life.
- Instrumental tests, such as ultrasound and magnetic resonance imaging. In most cases they are not necessary, but they could be requested by the doctor upon completion to better assess the degree of severity of the prolapse.
In the case of severe ulcers, a biopsy may be required to rule out the presence of carcinoma.
Obviously the type of treatment varies according to the severity of the prolapse
There is no specific treatment for mild prolapse.
It would be good to intervene with some good practices – recommended to all women to keep their pelvic floor healthy – which in the event of a small protrusion could make it regress.
The most recommended remedy is Kegel exercises or special balls to strengthen the pubic muscles.
It would be excellent, then, to lose weight in case of severe overweight and obesity and to avoid lifting heavy objects.
These remedies, however, only work if practiced with a certain constancy and especially in minor cases.
In cases of moderate prolapse, the use of the pessary is useful, in association or not with estrogen-based hormonal therapy as established by the referring gynecologist.
The pessary is a ring made of flexible material, such as rubber or silicone, which must be inserted deeply into the vagina in order to mechanically support the pelvic organs and avoid prolapse.
The specialist will obviously be the one to instruct the patient in the correct use of the device.
As far as estrogens are concerned, their use can be justified by the effects they have on the tonicity of the pelvic floor, and by the fact that during menopause there is a drastic reduction in the production of estrogens with consequent weakening of the pelvic muscles themselves.
Unfortunately, these treatments may backfire.
In these cases, or in those of more severe prolapse, the only resolutive therapy is represented by surgery, which consists in returning the prolapsed organs to their regular anatomical location.
Specifically, the intervention is particularly necessary in cases where the patient’s quality of life is compromised by the disorder.
In the case of uterine prolapse, in addition to the repositioning of the uterus in its anatomical location and the possible repair of the damaged portion of the pelvic floor, a hysterectomy, i.e. removal of the organ itself, can be evaluated.
Obviously the choice of the type of intervention will depend on a careful evaluation by the specialist on the basis of the patient’s clinical history and her general conditions.
Prevention
The best medicine, however, is always prevention: keeping your pelvic floor in good health will help prevent prolapse in some cases.
How to do? A good way is to practice Kegel exercises consistently: you can do them anywhere and in any position.
They are simple exercises, consisting for example in contracting the pelvic floor muscles for 5-10 seconds and relaxing for the same time 10 times.
As far as lifestyle is concerned, it is useful to eat adequately, with a diet rich in fiber and water to avoid constipation; you must avoid lifting heavy weights incorrectly; quitting smoking in the case of chronic bronchitis is strongly advised; finally, in overweight or obese subjects it is useful to lose a few kilos.
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