Genitourinary Prolapse
Genitourinary prolapse results into protrusion of vaginal walls and/or uterus. It occurs when there is descent of one or more of the pelvic organs including the uterus, bladder, rectum, small or large bowel, or vaginal vault. The front (anterior) and/or back (posterior) walls of the vagina, the uterus and/ or the top of the vagina (Vaginal Vault) can all be affected by this descent. It is usually accompanied by urinary, bowel, sexual, or pelvic symptoms.

The pelvic organs are mainly supported by the muscles of the pelvic floor (levator ani) and a connective tissue network connecting the organs to the pelvic muscles and bones (the endopelvic fascia). This support structure is weakened through direct muscle trauma, neuropathic injury, and disruption or stretching due to number of reasons.

Risk factors
• Increasing age (risk doubles with each decade of life).
• Vaginal delivery
• Increasing parity
• Overweight (BMI 25-30) and obesity (BMI >30)
• Spina bifida
• Intrapartum variables (controversial and unproven):
    o Large baby
    o Anal sphincter injury.
    o Very long second stage of labour (after full dilatation)
• Race
• Family history of prolapse
• Chronic Constipation
• Connective tissue disorders, e.g. Marfan's syndrome, Ehlers-Danlos syndrome
• Previous hysterectomy
• Menopause: a recent small study found no association between oestrogen status and prolapse
• Selective oestrogen-receptor modulators
• Occupations involving heavy lifting

For complete information regarding prolapse download the PDF

Treatment Options

Evaluation of prolapse involves thorough history taking. It is important to determine your main symptoms and the effect of these on their daily life.
It is necessary to fill up specific quality of life questionnaire to determine this.

The examination to determine the extent of prolapse is required in both standing and lying on your back or onto your side. If there are bowel symptoms, rectal examination can be helpful.

Specific investigations like ultrasound scans and Urodynamics (Bladder pressure studies) are required in certain situations.

Treatment is required only if Prolapse is causing symptoms that affects you. The options are Pelvic floor exercise, insertion of vaginal pessaries and surgeries. The surgical treatment is possible through vaginal, abdominal or key hole. Commonly offered surgeries are Vaginal hysterectomy, anterior and/or posterior colporrhaphy, sacrocolpopexy, sacrospinous fixation and mesh surgery. The choice and extent of surgery depends on patient's choice, surgeon's preferance, previous surgeries and other conditions.

• If prolapse is an incidental asymptomatic finding; without any symptoms no treatment is required. Though it is advisable to start pelvic floor exercise.
• The current management options for women with symptomatic genitourinary prolapse are:
    o Watchful waiting
    o Vaginal pessary insertion