Prolapse in women: symptoms, cause and treatment

Prolapse in women symptoms depend on the type and extent of the prolapse. A prolapse of the uterus, bladder or rectum is caused by stretching or damage to the pelvic floor muscles. These organs are then no longer held in place. The uterus, bladder and/or rectum then descend into the vagina. In the worst case, they can even come out.

• What is a prolapse?
• Cause of prolapse in women

• Weaker pelvic floor muscles
• Factors that play a role in the development of a prolapse

• Symptoms of prolapse in women

• Bladder prolapse symptoms
• Rectal prolapse symptoms
• Uterine prolapse symptoms

• Therapy

• Training the pelvic floor muscles
• Ring (pessary)
• Operation

What is a prolapse?

The uterus, bladder and rectum are held in place by ligaments, muscles (of the pelvic floor) and other tissues. When these ligaments and muscles are no longer strong enough, one or more of these organs can prolapse and partially protrude. This is called a ‘prolapse’: a prolapse of the uterus, a prolapse of the bladder or a prolapse of the rectum. Due to a prolapse, the organ in question no longer functions properly, which can lead to unwanted urine loss (incontinence), problems with defecation or complaints during sexual intercourse.

Cause of prolapse in women

Weaker pelvic floor muscles

Although prolapse mainly occurs in old age, some younger women also suffer from it. It mainly has to do with the weakening of the pelvic floor muscles and connective tissues and not everyone has an equally strong pelvic floor. There are women who naturally have weak connective tissue. In addition, the pelvic floor may be weakened or even damaged as a result of childbirth, heavy physical labor, obesity and frequent coughing due to, for example, smoking or as a result of lung disease. Prolapse mainly occurs after menopause. The ligaments in women become weaker due to lower estrogen levels. Chronic constipation and the resulting hard straining can make prolapse worse.

Factors that play a role in the development of a prolapse

Several factors play a role in the development of a prolapse, which often involve an accumulation of factors:

(Source: Prof. Dr. Jan-Paul Roovers, p. 34)

Symptoms of prolapse in women

Various complaints can arise with a prolapse, depending on the type and extent of the prolapse. However, not all subsidence causes complaints. The symptoms that occur often worsen during the day or after physical exertion. The complaints often subside after rest.

Bladder prolapse symptoms

The following symptoms may occur with bladder prolapse:

• a feeling of prolapse and pain in the vagina, a bulge in the front of the vagina;
• pain during intercourse;
• difficulty emptying the bladder, difficulty urinating properly, which increases the risk of a bladder infection;
• have difficulty holding in urine.

Rectal prolapse symptoms

The following complaints may occur with a rectal prolapse:

• the development of a bulge at the back of the vagina;
• a ball feeling around the anus and/or vagina;
• difficulty defecating, even if you feel the urge;
• sometimes the stool comes out suddenly during urination;
• after defecating you may have the feeling that something remains in the intestine;
• the rectum can come out (in its entirety) through the anus.

Uterine prolapse symptoms

The following symptoms may occur with a uterine prolapse:

• the feeling that something is coming out or sticking out of the vagina or a ball feeling between the legs;
• a nagging pain in the lower abdomen, legs or groin, which can radiate to the back, sometimes accompanied by enormous fatigue.
• sitting and cycling can cause problems.
• pain during sexual intercourse; and
• difficulty urinating, including involuntary loss of urine (incontinence), or frequent urination (needing to urinate more often).

You can also have a combination of these complaints if different organs (bladder, rectum and/or uterus) have prolapsed at the same time.

Therapy

If you have no complaints, treatment is in principle not necessary. Losing weight and properly treating underlying medical problems, such as lung disease and chronic constipation, can slow the progression of prolapse. Depending on the severity of the complaints, the doctor’s findings, your physical condition and your own wishes, several treatments are possible. In case of a deficiency of female sex hormone, vaginal suppositories or vaginal creams can be prescribed. Other treatment options include:

Training the pelvic floor muscles

Pelvic physiotherapy is exercising the pelvic floor muscles, which are the muscles that support the bladder and uterus. With the help of special exercises, you work on strengthening your pelvic floor muscles, so that you can better absorb pressure during pressure-increasing moments such as hard sneezing, coughing and lifting. Through exercises you can also learn to deal better with complaints such as loss of urine and feces and difficulty urinating. Physiotherapy reduces the symptoms of the prolapse, but the prolapse itself is not resolved. Pelvic physiotherapy can sometimes help with few complaints. With longer-standing prolapse or with more serious complaints, exercising the pelvic floor muscles usually does not help and another treatment option will have to be considered.

Ring (pessary)

A soft ring or pessary is inserted into the vagina and rests on the pelvic floor, pushing up the prolapsed tissue. There are different pessaries in all shapes and sizes, for different types of prolapse. A ring pessary often makes it easier to hold urine during exercise, for example. You will not feel a properly fitting ring, not even during sexual intercourse. A ring is not possible for all prolapses. This depends, among other things, on the type of prolapse, the severity and the firmness of the pelvic floor. A pessary can sometimes cause complaints such as vaginal discharge, blood loss and worsening urine loss.

Operation / Source: Istock.com/kzenon

Operation

If the above options do not provide sufficient relief, your GP can refer you to a gynecologist. Depending on the type of prolapse and your wishes, different types of operations are possible for prolapse. Most operations are performed through the vagina, sometimes by means of keyhole surgery, also called ‘laparoscopy’. It is sometimes advised to use a plastic mesh or implant during the operation, whereby the body responds by depositing new supporting tissue around the mesh.

A surgical procedure often has the advantage that your complaints reduce or even disappear completely. Keep in mind that complications may occur or that the complaints may return after a number of years.

read more

• Vaginal prolapse: vaginal prolapse symptoms & treatment
• Uterine prolapse: symptoms, causes and treatment
• Rectal prolapse: symptoms, cause and treatment
• Bladder prolapse or prolapsed bladder: symptoms and treatment
• Not being able to urinate: causes of urinary retention in men and women