Treating a prolapse is not a medical emergency when there are no complications. General prolapse is a frequent pathology in women that does not present, in most cases, any particular complication. What is prolapse, and how can it be best treated to avoid recurrence?
What is genital prolapse?
Genital prolapse refers to the descent of various organs into the vagina. The number of organs and the extent of the descent determine the need for prompt surgical intervention. Studies estimate that 40% of women over 45 years of age have a more or less significant prolapse following a gynecological examination. Only 10% of these cases will require surgery.
Different parameters that can lead to organ descent are taken into account: age, number of pregnancies, situations that put pressure on the perineum (chronic cough, sports, obesity, etc.).
The main sensation is a pressure in the lower abdomen, arising when standing and increasing during an effort. A lump is usually palpable and may become visible in some cases, sometimes requiring reintroduction.
Other symptoms may occur: itching, bleeding, difficulty in urinating, discomfort during intercourse, anxiety, etc.
Diagnosis and examination
The gynecologist asks the patient a series of questions to identify a vaginal prolapse and the degree of discomfort caused. A self-questionnaire is sometimes filled out and validated in order to set up the appropriate protocol.
Following this, the gynecologist, according to the indications given, proceeds with the clinical examination.
The examination is performed in the classic gynecological position, using a speculum. Palpations and measurements are performed in order to locate each organ. At the end of this examination, the diagnosis is made and the prolapse classified.
Additional examinations can be performed, if necessary: pelvic ultrasound/MRI, debimetry, manometry, etc.
There are two types of treatment to cure prolapse, depending on its importance.
Symptomatic treatment: concerns benign prolapses without great pain, this treatment aims mainly at reducing discomfort and the sensation of a ball in the vagina. Several therapies are adapted: rehabilitation, medication, electro-stimulation, vaginal laser, etc.
Anatomical correction: concerns advanced prolapse causing real discomfort in daily life. There are mainly two techniques: surgery and the pessary. The latter is an intra-vaginal device that prevents the descent of the organs.
Concerning surgeries, there are three ways to treat prolapse, in order to fix the organs in the pelvis:
laparotomy: little practiced, because often not necessary. This surgical procedure, performed under general anesthesia, aims to open the abdominal cavity to access the organs;
laparoscopy: this operation, under general anesthesia, is performed to put the organs back in place by suspending them with surgical strips. The operation lasts one to two hours and is followed by a period of 8 to 15 days off work, depending on the case;
vaginal route: performed under local anesthesia, this procedure usually requires the removal of the uterus to replace the rectum and bladder with prostheses and ligaments. The hospitalization usually lasts 3 days and the time off work 8 to 15 days.
Following these operations, sexual intercourse is possible again after healing, that is, about 1 month after the operation. However, it is necessary to take care of the high risk of recurrence by avoiding any excessive effort following the operation and to hydrate properly in order to avoid the risk of constipation.
Incontinence due to prolapse is also treated by surgery, under local anesthesia, by placing a cord under the urethral canal.
Each of the proposed treatments has advantages and disadvantages that must be discussed before any decision is made. It is important to know that there is no common protocol that is valid for all women, it is a matter of studying each case and proposing the appropriate treatment. During your appointment with the gynecologist, clearly state the extent of the discomfort caused by the prolapse to ensure that you are treated as well as possible.