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Genitourinary prolapse occurs when the normal support structures for the organs inside a women’s pelvis (uterus, bladder and lower bowel/rectum) are weakened and no longer effective. The result is that one or more of the organs can drop down into the vagina. When this happens it is known as prolapse. This may lead to no symptoms at all but more usually causes discomfort in the vagina as well as other symptoms, including urinary and bowel problems.
Depending on which part of the pelvis is affected, genitourinary prolapse is divided into the following (different parts of the pelvis can be affected at the same time):
Front of the pelvis (anterior)
Rear of the pelvis (posterior)
Middle of the pelvis
It is difficult to estimate how many women are affected by genitourinary prolapse because many women do not visit their doctor for help. It is thought that up to 50% of women who have had children have some degree of prolapse but that only 10% of those with prolapse seek medical advice.
The following may increase the risk of genitourinary prolapse:
There are a number of things that may help to prevent genitourinary prolapse, such as:
There are certain symptoms that women with all types of prolapse can have, such as:
Symptoms are usually worse after long periods of standing and they improve when lying down. Other symptoms depend on the type of prolapse. Some women do not have any symptoms at all but this is rare.
The following are common with prolapse that affects the urethra and bladder (anterior part of the pelvis):
The following are common symptoms for prolapse that affects the rectum (posterior part of the pelvis):
If you have little in the way of symptoms, you may choose to wait and see if they become worse. It is a good idea to visit your doctor for regular check-ups in case you develop any new symptoms.
There are a number of things that you may be able to do to help prevent the prolapse from getting any worse:
Pelvic floor exercises
Pelvic floor exercises are recommended for all women with GU prolapse, however they are not likely to improve prolapse that is already present. The exercises help to stop mild degrees of prolapse from getting any worse and to relieve symptoms such as abdominal discomfort and backache.
Vaginal oestrogen creams
For mild prolapse, oestrogen cream applied to the vagina may help ease feelings of discomfort. Symptoms may return once the cream is stopped.
A vaginal pessary is recommended for women who do not wish to have surgery, are waiting for surgery, or who have other illnesses that make surgery risky.
The pessaries are usually in the shape of a ring and made of silicone or plastic. They are inserted into the vagina and left in place to help lift up the walls of your vagina and any prolapse of your womb. They should be changed every 6 to 12 months.
Vaginal pessaries rarely cause any problems but have been known to affect the skin inside the vagina, which can become ulcerated. Some women experience some discomfort during sexual intercourse.
The aim of surgery is to provide a permanent cure for genitourinary prolapse and there are various operations available, depending on the type of prolapse. Your Consultant can advise which operation is best for you.
You are likely to need to stay in hospital for a few days after your operation. Full recovery may take up to six to eight weeks. You should avoid heavy lifting and sexual intercourse during this time. There is a small chance that a prolapse can return after surgery.
Left untreated, GU prolapse will usually gradually get worse. The outlook is best for younger women who are of a normal weight and are in good health. The outlook is worst for older women, those in poor physical health and those who are overweight. GU prolapse can return after surgery in about 16% of women.