Dr Marine Lallemant meets patients every day who are living with genital prolapse or organ prolapse. This condition is far more common than people think. It weighs heavily on quality of life and can affect women at any age. In this article, she sets out this condition for us, from the appearance of the first signs through to diagnosis and treatment of female genital prolapse.
By going through the key stages of this disorder, you will:
- Identify the mechanism & recognise the warning signs: understand the weakening of the pelvic floor and learn to listen to your body's signals.
- Assess the risk factors: identify the everyday pressures that weaken the pelvic floor and encourage a prolapse to appear.
- Discover pelvic floor rehabilitation solutions: explore the care options, from working with a professional to exercises at home with the Emy Trainer pelvic floor probe, to build lasting pelvic support.
What is female genital prolapse?
A prolapse is the consequence of a slackening affecting part or several organs of the lower abdomen. This condition, commonly called organ prolapse, refers to a situation where organs are no longer properly supported.
When a woman has a genital prolapse, one of her pelvic organs (bladder, uterus, rectum) slides downwards. In other words, into the vagina.
In the most severe cases of organ prolapse, it can even come outside beyond the vulva. This is the fourth and final stage of prolapse.
It is also possible for several organs to descend at the same time. However, note that it is difficult to assess how frequent this condition is. According to studies, it would affect between 4 and 97 % of women. The figures vary with the method used to collect the information (questionnaire or clinical examination).
The different types of prolapse in patients
There are several forms of pelvic prolapse. The classification depends on which organ descends. We therefore speak of:
- Cystocele : for the descent of the bladder. The patient may then have urinary leaks, difficulty urinating and frequent urinary infections.
- Urethrocele: for a prolapse of the urethra. This is the stage preceding cystocele, when only the urine outflow duct descends into the vagina.
- Hysterocele: to describe a uterine prolapse. The descent of the uterus and the cervix into the vagina often results from obstetric trauma or ligament weakness.
- Rectocele : for the descent of the rectum (rectal prolapse). Rectal or wind incontinence can occur because the organ presses on the posterior wall towards the anus.
- Enterocele: when the prolapse involves the intestine. This descent from the upper part of the vagina can cause chronic constipation.
How does an organ prolapse happen?
To better grasp this process in the pelvis, let us take an anatomical look. A triple system holds the pelvic organs inside the body:
- The pelvic floor muscles (or perineum). Shaped like a hammock, this support system runs from the pubis to the coccyx. It is on this group of muscles that the pelvic organs rest (bladder, uterus, rectum).
- The ligaments. They act as a system suspending and anchoring the pelvic organs to the bones of the pelvis.
- The fascias, which provide cohesion between the pelvic organs.
The integrity of this whole system is therefore essential to ensure a correct balance. It must be both supple enough to adapt to pregnancy and childbirth, and strong enough to withstand abdominal pressure, and even excess pressure (sport, straining).
Yet it happens that the pelvic floor muscles or the ligaments slacken. This slackening then leads to an organ descent, which will press on the vaginal wall and deform it. A descent that will sometimes go as far as coming outside the vagina.
What causes a prolapse?
First, note that the factors encouraging organ prolapse can be modifiable or permanent.
Generally speaking, the triggering and/or aggravating factors are many:
- Pregnancies, especially when multiple and/or repeated.
- Repeated and/or difficult vaginal deliveries.
- Delivery with a long labour.
- Difficult delivery with severe perineal tearing.
- Midline episiotomy.
- High birth weight of the newborn.
- Menopause, which brings a slackening of muscles and ligaments.
- Surgery on a pelvic organ.
- Repeated abdominal pressure: excess weight, carrying heavy loads, intensive sport, constipation, chronic cough or a sedentary lifestyle.
- A disease causing collagen deficiency, the protein essential to the cohesion, support and strength of tissues. For example, vascular Ehlers-Danlos syndrome.
- Neurological conditions affecting the pelvic floor (spina bifida, cauda equina syndrome, and so on).
Finally, a woman can develop a prolapse at any point in her life. However, the frequency increases with age, particularly after 50. The risk of surgery for a prolapse after 70 is 11 %.
The symptoms of female prolapse
Let us now look at the symptoms of organ prolapse. The most common are the sensation of a vaginal bulge and the sensation of heaviness.
Besides pelvic heaviness and the feeling of a bulge at the vaginal opening, an affected person may have:
- Urinary symptoms: urinary incontinence (urine leaks), pollakiuria (frequent urination), as well as urgency (sudden need to urinate) and bladder emptying problems. In that case, she has difficulty urinating and/or emptying her bladder fully.
- Ano-rectal problems: constipation, difficulty emptying the rectum or anal incontinence (leakage of wind or stools).
- Sexual problems: bleeding, pain, urine leaks, vaginal wind during intercourse or loss of sensation.
Some patients even carry out manual manoeuvres to urinate or pass stools, or to push the prolapsed organ back into the vagina.
Prolapse and sexuality: can intercourse continue?
Having a prolapse does not rule out sexual intercourse, but inconveniences (discomfort, unease, leaks) can arise. The solution? Strengthening the pelvic floor through targeted exercises, which helps improve the quality of the tissues and self-confidence. Using a suitable lubricant is also strongly recommended.
What to avoid when you have a prolapse
Certain behaviours can make the situation worse:
- Carrying heavy loads: always engage a protective contraction before the effort.
- High-impact sports: the shock waves weaken the tissues.
- Straining when passing stools: use a footstool to raise your legs and make evacuation easier.
- Holding your breath: breath-holding increases pressure in the abdomen.
I have an organ prolapse: what should I do?
To find out whether you really do have an organ prolapse, a clinical examination is needed. A simple examination may be enough.
But generally, the healthcare professional also carries out further tests, such as a pelvic ultrasound or a urodynamic assessment. This depends in particular on the type of prolapse and how far it has progressed.
The responsible or aggravating factors must first be identified. Then, conservative treatments are considered to relieve the patient without resorting to surgery.
Once the problem is identified, several solutions exist (before any surgical procedure) to treat you:
- Lifestyle: weight loss, a more balanced diet and suitable physical activity (gentle exercise, swimming…)
- Fitting a pessary: this is a silicone or latex device inserted into the vagina. This medical device (ring or cube) holds the organs in place. It can be combined with hormone treatment.
Prolapse and pelvic floor rehabilitation
In addition, healthcare professionals often recommend pelvic floor rehabilitation. The aims are to prevent or slow the worsening of the prolapse. At the same time, strengthening the pelvic floor helps prevent the risk of incontinence.
What is more, pelvic floor rehabilitation is very useful after prolapse surgery. Both to help the pelvic floor recover and to avoid a recurrence.
In practical terms, it is a multifactorial, whole-body rehabilitation, through contractions and releases of the pelvic floor. It improves the tone of the pelvic floor, the abdomen and the thoracic diaphragm, and more broadly the lumbo-pelvic alignment.
Beyond sessions with a midwife or physiotherapist, pelvic floor rehabilitation includes self-rehabilitation at home.
In that setting, you can use a connected biofeedback device, such as the Emy pelvic floor probe. It will help you improve your exercises and progress the right way.
Surgical treatment of genital prolapse
Finally, conservative treatments may not work. On their own or in addition, surgery must then be considered to put the organs back in place.
Surgical treatment depends on the type of prolapse. It can be carried out by the vaginal route or the abdominal route (often by laparoscopy). The operation involves tightening the tissues. Good post-operative follow-up is then essential.
Surgery is the last resort when the organ prolapse reaches an advanced stage and causes disabling symptoms. In particularly complex cases, a multidisciplinary pelviperineology team meets to decide how the operation should be carried out. The choice of technique then depends on various criteria: symptoms, type of prolapse, comorbidities, the patient's expectations…
Of course, surgery will always be combined with managing the modifiable risk factors.
Key takeaways for your pelvic health
Acting on an organ prolapse is essential. Never hesitate to contact or consult a professional at the first signs. Information, early diagnosis, a healthy lifestyle and rehabilitation are your best assets for preserving your intimate comfort.
- Organ prolapse is not inevitable: known as prolapse, this disorder is a slackening of the supporting tissues. By acting early on your habits (stopping strong abdominal pressure), you can stabilise the situation.
- Consult a professional: a healthcare professional is essential to make an accurate diagnosis and choose the treatment suited to your stage.
- Strengthen your pelvic floor precisely: active rehabilitation is the key. Using a biofeedback probe such as Emy Trainer lets you work effectively at home.
Sources
- Prolapsus génital de la femme : des solutions pour le traiter, Haute Autorité de Santé (HAS), Mai 2022, Guide usagers – link
- Prospective evaluation of the connected biofeedback EMY Kegel trainer in the management of stress urinary incontinence, Jochum F et al., February 2022, Journal of Gynecology Obstetrics and Human Reproduction 51(2):102280 – link
