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Physiotherapy => Backache => Prolapse
Prolapse
INTRODUCTION
Prolapse, in gynaecology, the downward displacement of the uterus or vagina (utero-vaginal prolapse) towards or through the introitus (vaginal opening). Prolapse of the uterus may be first degree (descent of the cervix to the introitus), second degree (descent of the cervix but not the whole uterus beyond the introitus), or third degree (descent of the whole uterus beyond the introitus). Vaginal wall prolapse may also include the bladder, urethra (urinary passage), rectum, and intestine. The condition differs widely in incidence largely because of differences in childbirth practices, number of children, pelvic anatomy, and cultural habits.
CAUSES
Utero-vaginal prolapse arises because of the thinning of the mechanisms supporting the uterus, including the para-cervical ligaments. This may occur because of damage sustained during childbirth; weakening as a result of low levels of the female hormoneoestrogen after the menopause; or congenital weakness. It may be exacerbated by increased pressure within the abdomen due to smoking, constipation, abdominal masses, and chronic bronchial conditions such as obstructive airways disease.
SYMPTOMS
Most patients experience symptoms of "something coming down" although these do not correlate automatically with the severity of the prolapse. Other symptoms include urinary disturbance, backache, abdominal pain, ulceration, and painful sexual intercourse. The diagnosis is confirmed by gynaecological examination.
TREATMENT AND PREVENTION
Conservative treatment includes exercises for the pelvic floor muscles, hormone replacement therapy, and ring pessaries. Surgery is carried out where conservative measures have failed or are inappropriate. The definitive procedure for uterine prolapse is vaginal hysterectomy. Repair operations are employed for vaginal wall prolapse. For women who still want to become pregnant, an alternative to vaginal hysterectomy is a technique known as a Manchester Repair, which combines shortening of some of the supporting ligaments and partial shortening of the cervix. In these cases, subsequent pregnancies are delivered by Caesarean section. Prevention is aimed at improving care before, during, and after childbirth, and also includes the appropriate use of hormone replacement therapy.
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