Female genital prolapse

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 28, 2016
StartDiseasesFemale genital prolapse

Female genital prolapse, also called pelvic organ prolapse, affects an estimated 34 million people worldwide and can strike women from their childbearing years through menopause

Contents

Definition & Facts 

When there is a protrusion of the internal pelvic structures from the vaginal opening, female genital prolapse has occurred. This often painful condition can involve the urinary bladder, small bowel or rectum. Considered extremely common among women worldwide, this condition has been historically described for as many as 4,000 years.

Childbirth and menopause are cited as the most common causes of the disorder, with estimates that at least 50 percent of the female population will exhibit symptoms of female genital prolapse in their lifetime. This disorder can occur at any time during a woman's life, with injuries to pelvic tissues sustained during childbearing sometimes taking years to result in prolapse.

Symptoms & Complaints

Patients suffering from genital prolapse may notice a reduction in sensations during intimacy, as well as a release of stool or urine during sex, while reports of painful intercourse are more prevalent.

Feelings of pain or pressure in the pelvic area are common, as is the appearance of non-menstrual bleeding or spotting. Patients may report finding a lump or protrusion at the vaginal opening.

They may also experience fecal incontinence, urinary retention or chronic constipation. Some patients experience the feeling that an organ is going to fall out of the vagina. Pain in the lower back or pain in the groin is occasionally reported.

Individuals may experience difficulty using feminine hygiene products that require insertion into the vagina such as tampons as well as menstrual cups, with either the inability to position them properly or to retain them. Symptoms are reported to worsen when jumping or lifting, with marked relief from lying down. 

Causes 

Female pelvic prolapse can be caused by several factors individually or a combination of several. Menopause normally occurs between the ages of 45 and 50 and marks the end of a woman's menstrual cycle and can cause genital prolapse from the lack of estrogen produced by the body. The reduction in estrogen causes a thinning and weakening of the tissue that holds pelvic organs in place.

Women with a family history of pelvic prolapse are more likely to experience this condition. Difficult childbirth can weaken or damage pelvic tissue and cause prolapse later in life. The strain of repetitive heavy lifting, such as carrying children, can affect the strength of the pelvic muscles. Repetitive, jarring exercise, like long-term daily jogging, can weaken pelvic floor muscles and lead to female genital prolapse.

Obesity contributes to the risk of prolapse due to the additional pressure placed on the abdomen. Smoking and respiratory disease, which lead to chronic coughing, increase the risks. Hysterectomy, the removal of the uterus, for other medical reasons may leave pelvic muscles and organs unsupported, leading to prolapse. Spinal cord injury or spinal disease can lead to paralysis of the muscles supporting the pelvic area, increasing the risk of prolapse of organs and tissue.

Diagnosis & Tests

When female genital prolapse is suspected, the first diagnostic step is to conduct a pelvic examination. This simple procedure will verify if prolapse has occurred, as well as whether the bladder or bowel is involved. Once the type of prolapse is identified, the physician may order other tests.

The exam may include a digital rectal examination to inspect the bowel for involvement. Other tests may include a pelvic ultrasound, pelvic magnetic resonance imaging (MRI), and tests that measure the strength of the pelvic floor. If menopause is suspected as the cause of genital prolapse, tests will include an evaluation of hormone levels.

A cystourethroscopy, performed by a urologist, includes inserting a tube through the lower urinary tract and into the bladder, which allows the cystoscope to gain access into the bladder. This procedure will allow the urologist to visually evaluate the bladder for any damage.

The pelvic organs can also be viewed for position and size by an X-ray test called an intravenous pyelogram (or IVP.) A computed tomography (CT) scan also uses X-ray to examine the condition of the bladder, kidneys, and urethra. The results of these tests will assist the doctor in determining the stage of prolapse by showing the proximity of the prolapsed organ to the opening of the vagina.

Treatment & Therapy

Not everyone who is diagnosed with female genital prolapse chooses to receive treatment. The decision to treat the disorder is based on a number factors, including the severity of the prolapse and its interference with daily life, sexual activity, other medical diagnoses and age.

If treatment is needed, many experience relief from symptoms via nonsurgical practices. Kegel exercises and a removable supportive device, called a pessary, are common nonsurgical choices as are hormone replacement therapy and specialized support garments. Patients may opt to try physical therapy as a nonsurgical treatment solution.

Surgery is indicated if the patient is experiencing pain or the condition is affecting bowel or bladder function. The type of surgery performed is determined by the type of prolapse diagnosed. A hysterectomy may be indicated when the uterus is the prolapsed organ or is causing the displacement of other tissue.

Other surgeries are performed to correct the prolapse of supporting tissue or to repair the wall of the vagina. In addition to traditional surgical procedures, new technologies include laparoscopic and robotic treatments. Laparoscopic surgery uses small incisions through which a lighted scope and other instruments are inserted to perform repairs to the affected tissue. 

Prevention & Prophylaxis

Women can reduce their risk of developing female genital prolapse by seeking medical treatment for chronic cough which reduces the risk of putting extra strain on the pelvic tissues. Maintaining a normal body weight, consuming a diet high in fiber and staying hydrated as well as regularly performing pelvic floor muscle exercises are all good practices.

Avoiding repetitive activities that put stress on genital muscles and learning to lift safely, using arm muscles and leg muscles may also reduce one's risk of female genital prolapse. When experiencing constipation, one should seek treatment either from over-the-counter remedies or from one's physician. Straining associated with constipation can damage tissue.