Prolapse

Weaknesses in the vagina and the support ligaments holding the bladder, rectum and uterus in place can cause the descent, or dropping, of an organ into the vagina. This condition is called prolapse and can be quite an uncomfortable situation.

The constant feeling that something is falling down and out the vagina (indeed it is!) can be quite painful and result in low back pain as well as dyspareunia (painful sexual intercourse). Prolapse is a common after-effect of hysterectomy, typically occurring 5-10 years after the procedure, but is mainly considered to be one result of childbirth. During childbirth, as with hysterectomy, the pelvic structural ligaments are sometimes damaged creating a weakness in pelvic structural support. This in turn, and over time, leads to prolapse.

There are two types of prolapse: uterine prolapse and vaginal prolapse. Uterine prolapse refers to the uterus dropping down into the vagina. It typically drops in stages until, at some point in time, it actually appears at the entrance to the vagina. Vaginal prolapse refers to the dropping of other organs into the vagina and each one of these organs has their own name for this occurrence.

Type of Vaginal Prolapse	Description
Cystocele	Part of the bladder drops into vagina.
Cystourethrocele	Combination of bladder and urethra dropping into vagina.
Enterocele	A loop of intestine drops between the rectum and vagina.
Rectocele	Wall of the rectum protrudes into the vagina.
Urethrocele	The urethra drops into the vagina.

Symptoms from vaginal prolapse include bladder weakness with urine leakage, urinary tract infections, a feeling of downward pressure in the vagina, pressure on the rectum and inability to completely empty all fecal matter. Dealing with prolapse can range from using a pessary (a rubber device inserted into the vagina to support the uterus in place), to surgery that repairs the muscles and ligaments and repositions the pelvic organs, to vaginal hysterectomy.

The presence of fibroids can certainly complicate matters and place even more undue pressure on the downward advance of a woman's organs. On the other hand, fibroids that are quite large can serve, in some ways, as a blocking mechanism to prolapse. Either way, the situation is most likely to be extremely uncomfortable. Surgery to repair any prolapse may require surgery to remove uterine fibroids at the same time. Under these circumstances, an urogynecologist -- a gynecologist with advanced training in urology, specifically treatment of incontinence and prolapse -- may be the best type of physician to consult.

Link	Site Name/Author	What You'll Find
home.ici.net/~stacy/prolap.htm	Choices for Uterine Prolapse Society, Inc. (CUPS)	Non-profit organization created as a resource for women who have been diagnosed with Uterine Prolapse.
www.augs.org/index.html	American Urogynecologic Society	Doctor locator. You'll need this to locate a urogynecologist -- someone who specializes in prolapse and correction of this problem.
www.iuga.org/	International Urogynecological Association	The International Urogynecological Association is an international organization committed to promoting and exchanging knowledge regarding the care of women with urinary and pelvic floor dysfunction.
www.emedicine.com/ med/topic3325.htm	Howard A Shaw, MD eMedicine Journal, June 27 2001, Volume 2, Number 6	Rectocele. Excellent explanation along with interactive graphics of surgical repair techniques.
respiratorycare.medscape.com/ Medscape/WomensHealth/ journal/1998/ v03.n04/wh5182.cesp/ wh5182.cesp-01.html You must be registered at Medscape before this link will work.	Medscape Women's Health 3(4), 1998. R. Duane Cespedes, MD Cindy A. Cross, MD Edward J. McGuire, MD	Pelvic Prolapse: Diagnosing and Treating Uterine and Vaginal Vault Prolapse
respiratorycare.medscape.com/ Medscape/WomensHealth/ journal/1998/v03.n04/ wh3018.cesp/wh3018.cesp-01.html	Medscape Women's Health 3(4), 1998. R. Duane Cespedes, MD Cindy A. Cross, MD, Edward J. McGuire, MD	Pelvic Prolapse: Diagnosing and Treating Cystoceles, Rectoceles, and Enteroceles
www.bmj.com/cgi/ content/full/314/7084/875	British Medical Journal BMJ 1997;314:875 (22 March) Simon Jackson, senior registrar Phillip Smith, consultant Department of Obstetrics and Gynaecology Southmead Hospital Bristol BS10 5NB	Fortnightly review: Diagnosing and managing genitourinary prolapse. Medline review of the literature on prolapse.
www.niddk.nih.gov/ health/urolog/uibcw/index.htm	National Kidney and Urologic Diseases Information Clearinghouse	Let's Talk About Bladder Control for Women. Information in English and Spanish on issues related to urinary incontinence. Terrific brochure on doing those Kegals too!
womenshealth.medscape.com/ Medscape/WomensHealth/ journal/1997/v02.n08/ wh3075.appell/wh3075.appell.html	Medscape Women's Health 2(8), 1997. Rodney A. Appell, MD, FACS, Cleveland Clinic Foundation	Percutaneous Bladder Neck Stabilization for Stress Urinary Incontinence in Women: The Technique, Risks, Benefits.
www.uib.no/isf/people/inkter.htm	Hogne Sandvik	Treatment of female urinary incontinence - an annotated evaluation of non-surgical therapeutic options.
pov.net/womenshealth/ laparosc.htm	Michael R. Bishop, MD, PhD, FACOG Women's Health Alliance	Laparoscopic treatment of urinary stress incontinence.
www.rmed.com/bladneck.html	E.D. Riza, M.D. A.S. Deshmukh, M.D. Journal Of Laparoendoscopic Surgery, 1994, v4n5.	A Laparoscopic-Assisted Extraperitoneal Bladder Neck Suspension: An Initial Experience.
www.med.upenn.edu/ health/pf_files/penntoday/ v9n1/wh_1.html	University of Pennsylvania Health System Volume 9, Number 1 Winter 1998	Advanced Diagnostic and Surgical Treatment: Female Urinary Incontinence and Pelvic Prolapse.
www.wdxcyber.com/ nurinar2.htm#profix	Woman's Diagnostic Cyber	Having Prolapse Problems Fixed Without Hysterectomy - 10/17/99
www.icsoffice.org/publications /2000/POSTERS/PELVIC% 20FLOOR/pelvicfloor.htm	International Continence Society	Informally discussed poster papers on pelvic prolapse at the ICS 2000 conference.
www.ucsf.edu/wcc/ AboutBladderProbs_ anatomy.html	UCSF Women's Continence Center	About Bladder and Prolapse Problems: What Your Body Looks Like & What's Going On Down There. Terrific series of graphic slide images that displays organ placement and prolapse very cleanly and in simple terms.
www.dukeuroandgyncare.com /eval_tests.html#pelvic	Duke University Female Urology and Urogynecology Clinic	Summary of some of the tests used in the evaluation of urinary and fecal incontinence, problems with bladder emptying, and/or pelvic prolapse. Lots of additional info linked to this page about Duke's program.
www.swec.com.au/ newpage51.htm	Sydney Women's Endosurgery Centre Advanced Gynae-Endoscopic Unit Department of Obstetrics and Gynaecology St George Hospital University of New South Wales	Pelvic Floor Surgery (Prolapse). Includes graphic pictures of laparoscopic repair.
www.ecr.org/T/ ECR01/sciprg/abs/ pb0489.htm	A. Maubon, M. DeGraef, M.-P. Boncoeur-Martel, C. Courtieu, P. Marès, J.-P. Rouanet de Lavit; Limoges/FR	Does clinical examination under dynamic MRI improve the preoperative diagnosis of female pelvic prolapse?
www.spl.harvard.edu:8000/ pages/papers/fielding/ pelvic_floor.html	Fielding JR, Dumanli H, Schreyer AG, Okuda S, Gering DT, Zou KH, Kikinis R, Jolesz RA. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.	MR-Based Three-Dimensional Modeling of the Normal Pelvic Floor in Women: Quantification of Muscle Mass.
www.suffolkobgyn.com/ viewArticle?ID=9796	Indu S. Anand, MD	Enterocele. Description, diagnosis and treatment.
www.froedtert.com/ grandrounds/mayjune97/ page6.html	Froedtert Memorial Lutheran Hospital Julianne Newcomer, M.D., Assistant Professor, Obstetrics & Gynecology, Medical College of Wisconsin	Recurrent Pelvic Organ Prolapse.