A prolapse happens because the tissue supporting the pelvic organs become weak. In other words, the forces pushing the uterus and vagina down are stronger than the muscles and ligaments that hold them in place.
Normally, there are two methods that keep the uterus in position. Firstly, there is a small muscular band the stops the vagina from being pushed downward. This “band” closes the opening of the vagina and represents the pelvic muscles. Secondly, there are also ligaments which hold the walls of the vagina up to the sides of the body and this stops movement downwards. These two methods when working, keep the uterus in the correct position.
What Causes A Prolapse?
Childbirth is often the cause of prolapse in up to 50% of women as the muscles can be injured during the delivery process. Healing can sometimes come with a permanent weakness and occasionally there may also be nerve damage too which leads to a loss in muscle movement and an inability to hold the uterus, bladder or vagina (or a combination) in their normal position. An easy way to illustrate this would be to say that these muscles work just like a shopping bag does in containing items. If you were to get a hole in the bottom of the shopping bag, then everything would fall out and down. The muscles in the pelvic floor ensure that the organs (uterus and bladder) stay in the correct position. If damaged, then the pelvic floor no longer holds or supports to the same extent.
Age is a factor as the ligaments weaken, especially after the menopause as there is a natural loss of oestrogen. This is the hormone that helps the body make collagen, the protein responsible for enabling the supportive tissues of the pelvis to stretch and return to normal. As oestrogen declines are menopause, so does the amount of collagen.
Being overweight can increase the likelihood of a prolapse as can heavy lifting or manual work, long term constipation and persistent coughing. All these factors act as a constant “stress” on the level floor and over time, the pelvic floor weakens and prolapse can occur.
Genetic diseases such as Marfan Syndrome, joint hyper mobility syndrome and Ehlers-Danlos Syndrome (which affects collagen proteins in the body).
Previous pelvic surgery can also have an impact.
How Severe Can A Prolapse Be?
There are various levels of severity:
First degree: this is where the cervix drops into the vagina
Second degree: the cervix drops to the level just inside the opening of the vagina
Third degree: The cervix is outside of the vagina
Fourth degree: The whole of the uterus is outside the vagina. This condition is also called procidentia and it is caused by a weakness in all of the supporting muscles.
What Types of Prolapse Are There?
Anterior prolapse or cystocoele
This is where the bladder bulges into the wall of the vagina and can lead to urinary frequency, urgency, retention and incontinence. Simply put, it is when the anterior (the front) of the vaginal wall and bladder fall down or collapse. This is the most common form of prolapse and causes pressure in the abdomen as the muscles that have been holding the vagina and bladder in position are no longer able to.
Posterior prolapse or rectocele
This is where the bowel bulges forward into the back wall of the vagina. To clarify, this is where the back wall of the vagina and rectum fall down and protrude downwards and out.
Prolapse of the Cervix or top of the vagina
This is where the cervix or uterus drops and can be the result of previous treatment to remove the womb
Prolapse of the Uterus
This is when the uterus can no longer be held in position and falls down with gravity.
With all these different types of prolapse, it is possible to have just one type of prolapse, or a combination of more than one type.
This is when small bowel moves into the space between the vagina and the rectum created by weakening muscles
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