Dr Sarah Jarvis
My Weekly’s favourite GP from TV and radio writes for you
Prolapse is very common. Any tendency for the organs inside your pelvis – your womb, bladder or bowel – to drop down into your vagina counts as prolapse.
When you’re standing up, these organs are fighting against gravity, so it’s hardly surprising. But what can you do about it and what are the risks of treatment?
Your pelvic floor is a tough wall inside your pelvis, running under the skin around the entrance to your vagina and back passage. Your pelvis is a busy area – as well as your vagina, womb, fallopian tubes and ovaries, your bladder and the end of your large bowel share the space.
Prolonged or intense pressure on your pelvic floor can weaken the support structures. Childbirth is an obvious cause – both the pressure of a baby during pregnancy and all that pushing during childbirth. The more children you have, the greater the likelihood of prolapse. Anything else that increases pressure in your stomach cavity also makes prolapse more likely – constipation, chronic cough, being overweight and heavy lifting. A prolapse (posh medical name genito-urinary prolapse) happens when any one of these organs drops down into your vagina. The back of the bladder presses on the front of the vagina, while the front of the rectum (back passage) sits next to the back. Symptoms depend on what’s dropping down. Any kind of prolapse can cause a dragging sensation, or a feeling of a lump down below. If your bladder has prolapsed you may find yourself needing to pass water more often, leaking
A PESSARY FITTED INSIDE YOUR VAGINA AND CHANGED EVERY 6 MONTHS CAN BE AN EFFECTIVE WAY TO CONTROL PROLAPSE WITHOUT SURGERY
urine (when you cough, sneeze or laugh) or feeling your bladder hasn’t emptied when you go to the loo. If it’s the back passage, you may have problems opening your bowels, a sudden urge to go or a feeling that you haven’t emptied your bowels. Sex may also be uncomfortable.
If your symptoms are mild, regular pelvic floor exercises, losing weight and avoiding constipation may be enough. You should avoid heavy lifting, and stop smoking.
If symptoms are severe, your doctor may recommend surgery. The options all involve ways of strengthening and tightening the vaginal walls.
In recent years, several new versions have been introduced – a tape or mesh is used as a sling to support the womb or vagina. Sadly it’s become clear that vaginal mesh carries risks.
The problem can recur, just as with mesh-free procedures. More importantly, the mesh can sometimes erode the wall of the vagina or other organs; the result can be severe pain, impossibly painful sex, bleeding and bladder leakage. In June, 2017 the national body NICE put out new warnings. Mesh procedures can only be done: u By doctors who specialise in prolapse, doing the op regularly and getting up to date training on use of mesh u With warnings for all women about the risks of the problem recurring and the specific complications that erosions can cause u With written information on risks and benefits for all patients u If the local lead on quality of care in their NHS trust is kept informed u With details of all women entered on a central database, where every case of complications is documented so NICE can update guidance.
Some women may still decide prolapse surgery using mesh is their best option. At least they’ll be fully informed of the risks. Next week: Protect yourself from flu
PELVIC FLOOR EXERCISES NEED TO BE DONE REGULARLY AND IN THE RIGHT WAY TO HELP – ASK YOUR DOCTOR FOR REFERRAL TO A SPECIALIST PHYSIOTHERAPIST
IF YOUR SYMPTOMS ARE SEVERE, YOUR DOCTOR MAY SURGERY’’ RECOMMEND