What is it?
Prolapse is the displacement of an organ from its normal anatomical position.
In the photo below we can see the normal position of the pelvic organs.
And belo it is an example of a common type of prolapse, called bladder prolapse or cystocele. We can see that the bladderslides down and onto the anterior vaginal wall (front wall of the vagina)
Genital prolapse involves one or more of the following organs:
-uterus (hysterocele or uterine prolapse)
-small intestine (enterocele)
There is considerable individual variability with respect to the predisposition to prolapse and this condition appears to develop progressively.
Pelvic organ support is derived from a dynamic interaction of pelvic bones, endopelvic connective tissue, and pelvic floor muscles.
Risk factors are:
- number of vaginal deliveries, congenital factors, iatrogenic factors (mainly hysterectomy), increased intra-abdominal pressure in obesity and chronic respiratory diseases, connective tissue injuries, and neuromuscular support of the pelvic floor. The endopelvic fascia and the connective tissue of the pelvic floor could be injured during pregnancy as a result of a stretch or tear during vaginal delivery and their weakening is clearly seen after giving birth.
Another associated risk factor is menopause. Estrogens appear to play a significant role in maintaining active basal tone and tensile strength of the pelvic floor and when insufficient (as in post-menopausal and post-hysterectomy), it could cause some changes that result in pelvic floor weakness.
Traditionally, the management of prolapses consists of surgery or conservative treatment, pharmacotherapy or physiotherapy. Depending on the type of prolapse, physiotherapy can be the only treatment (if the prolapse is mild, the patient is not a good candidate for surgery or wishes to have more children) or in association with surgery or pharmacotherapy.
Physiotherapy treatment in patients with simple first-degree urinary incontinence or genital prolapse is recommended as first-line treatment by the World Health Organization (WHO).
A consultation with a physiotherapist specialized in pelvic floor is of vital importance for the correct management of genital prolapses.
A thorough assessment of the patient will guide the treatment.
Do you want to know more about the treatment for pelvic prolapse or have any question?
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