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Prolapse

Prolapse literally means "To fall out of place." In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is generally reserved for organs protruding through the vagina.

Definition

Prolapse can involve several structures within the pelvis:

  • The vagina
  • The bladder
  • The uterus (or the "stump" when the uterus itself has been removed by hysterectomy)
  • The rectum
  • The cavum Douglasi without the rectum
  • A combination of the above

A special case is "inversio uteri" (inversion of the uterus), a complication of childbirth
Symptoms include pain, incontinence of urine and/or feces, discomfort in specific positions (standing, bicycling).

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Types of prolapse

  • cystocele (bladder into vagina)
  • enterocele (small intestine into vagina)
  • rectocele (rectum into vagina)
  • urethrocele (urethra into vagina)
  • uterine prolapse (uterus into vagina)
  • vaginal vault prolapse (roof of vagina, after hysterectomy)

Diagnosis

Diagnosis is by history and physical examination. When generalised weakness of the pelvic floor is suspected, additional tests might be considered. When incontinence is a feature, urodynamics may give some information on the interplay between prolapse and the incontinence.

Therapy

Prolapses must be treated according to the severity of symptoms. They can be treated:

  • With conservative measures (changes in diet and fitness, Kegel exercises, etc.)
  • With a pessary, to provide support to the weakened vaginal walls
  • With surgery
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