By Dra. Johanna Vega & Dra. Vanda López
The female genital prolapse or vaginal prolapse and its treatment have always been an important chapter in urogynecology. Many women suffer from this condition silently, without knowing the clinical implications and treatment options available today to correct it surgically.
What is female genital prolapse?
Vaginal prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall out of their normal positions. This falling may occur in one or more of the following areas:
- Anterior prolapse: descent of the urethra and / or bladder.
- Apical prolapse: descent of the uterus or vaginal vault.
- Posterior prolapse: the intestine descends compromising the vagina.
What is the pelvic floor?
It is a group of muscles, ligaments, connective tissue and nerves that allow the holding, control and proper functioning of the uterus, vagina, urethra, bladder and rectum.
What are the causes of prolapse?
There is no single cause, but several predisposing conditions that may occur simultaneously have been identified. These are:
- Trauma during vaginal childbirth, multiple births or large fetuses (over 4 kilos);
- Poor quality of the ligaments and muscles which support the pelvic organs;
- Hormonal changes (menopause);
- Obesity, advanced age or previous pelvic surgery.
- It can also occur in young women without children, when there is a history of neurological diseases, family history or collagen diseases.
What are the signs and symptoms?
Depending on the type of prolapsed, symptoms vary, but there are some obvious signs and symptoms that you can tell your urogynecologist:
– Feeling of vaginal weight or pain in the lower abdomen.
– Sensation of a lump in the genitals.
– Difficulty, pain or dissatisfaction in sexual relations.
– Constipation or alterations in defecation.
– Involuntary loss of urine, increased urinary frequency, urgency to urinate or a feeling of incomplete emptying of the bladder.
How is it diagnosed?
Your urogynecologist should do a clinical history, since it is vital to establish the type of prolapse, identify possible causes of the defect and concomitant pathologies, and all urinary, fecal and / or sexual symptoms involved.
The physical examination is performed in the gynecological position, thus determining the degree of prolapse.
Type of prolapse:
Grade I: the decent does not reach the vaginal plane.
Grade II: the decline reaches the vaginal plane.
Grade III: the decline goes beyond the vaginal plane.
If a genital prolapsed is confirmed, what kind of treatments are available?
There are several non-invasive alternatives that seek to strengthen the pelvic muscles. However, in most cases, surgical correction is the solution, which seeks to alleviate the symptoms, maintain and possibly improve the functionality of the pelvic organs and restore the anatomy.
Depending on the type and degree of genital prolapse, patients can be treated surgically vaginally or abdominally using or not using synthetic materials, meshes to better support the pelvic organs. The anterior prolapse (bladder) and posterior (right) are approached vaginally and all defects are corrected. Within the abdominal correction techniques, we have the technology that allows us to perform these procedures by laparoscopy or assisted by the Da Vinci robot, for advanced prolapse.
What is the advantage of laparoscopic surgery and robotic-assisted surgery?
The use of these techniques allows the surgeon a better view of the entire pelvis, with easier access to anatomic spaces. This clarity of the surgical field makes it easier to analyze and identify the support defects of all the pelvic structures, achieve a correction which is more accurate and effective and with more satisfactory functional results.
Additional advantages include less blood loss, decreased postoperative pain with less need for medication, minimal scarring, shorter hospital stay, faster recovery and early resumption of work activity.
Who should be consulted to address this problem?
Traditionally this disease was treated by a gynecologist. However, genital prolapse is a large and complex event that includes sexual disorders, chronic pain, fecal and vesicle dysfunction. Under evaluation any of these aspects will lead to misdiagnosis and treatment, with a high probability of recurrence or long-term complications. Therefore it is important to refer the matter to the pelvic floor specialist (urologist, gynecologist) to orient the diagnosis and treatment of the disorders of that area.
How I can prevent genital prolapse?
It is not known exactly, but considering the risk factors, it is important to take into account several considerations:
It is important to strengthen the pelvic floor daily to improve elasticity and muscle strength, especially during pregnancy and after delivery. This is accomplished by performing pelvic floor exercises at home. Ask your doctor about the right way to practice these.
Hormone replacement therapy under supervision in menopausal women: also, prevent and treat obesity.
Annual checkups with your urogynecologist.
Translated by Weldon Woodard