What is it?
Genital prolapse is a condition that often affects more than one department. It can affect the bladder or the anterior vaginal wall, the uterus and rectum or the posterior vaginal wall. The most common form is prolapse of the uterus and the anterior vaginal wall or the bladder. About 13% of women in their 80s will need surgery to correct prolapse and about 50% of women who have given birth may have genital prolapse.
Which are the symptoms?
Genital prolapse, being a multi-chamber disease, is often accompanied by several concomitant symptoms, which have a great social, sexual and therefore psychological impact on the patient. The symptoms are divided into two types: those related to the presence of the prolapse itself, and those related to the disruption of the prolapsed organs. So, the symptoms associated with the prolapse itself are as follows:
- feeling of something coming out of the vagina;
- a sensation of pressure or heaviness in the vagina.
Symptoms related to prolapsed organs depend on the prolapsed organ:
- stress urinary incontinence or IUD (early stages)
- difficulty emptying the bladder (later stages).
- feeling of incomplete emptying of the bladder
- urinary incontinence during intercourse
- fecal urgency
- fecal incontinence
- feeling of incomplete evacuation
- need to help evacuation with acupressure
How is it diagnosed?
The diagnosis of genital prolapse is made on gynaecological-proctological examination. The prolapse of the anterior vaginal wall and/or uterus and/or posterior vaginal wall can be assessed in a standard lithotomy and orthostatic position using a speculum, and the patient is also asked to cough. Finally, transvaginal ultrasound is important to obtain information about the anatomical characteristics of the uterus and ovaries.
How is it treated?
It is suggested that surgery is only necessary if symptoms are present. The treatment of prolapse can be divided into medical and surgical treatment. Medical treatment is questionable in the early stages (I and II) and consists of pelvic floor rehabilitation. This can be done with exercises that the patient can do at home or with the help of staff specialising in pelvic floor rehabilitation. Instrumental treatments such as electrostimulation can additionally be used in the latter case. A pessary is another aid. A pessary is a silicone ring that, once inserted in the vagina, holds the uterus in place by creating friction with the vaginal walls. Regarding surgical treatment, there are currently two types of surgery: vaginal or fascial surgery, which repairs the flatus using the same tissue as the patient herself, with a 30% risk of recurrence; laparoscopic or robot-assisted surgery, which corrects the prolapse using mesh, currently titanium, which reduces side effects and guarantees longevity if properly fixed. In the first two stages, rehabilitation therapy is highly recommended. In the more advanced stages, the surgical technique should be chosen depending on the prolapsed section, the stage of prolapse, the main symptoms reported by the patient, the age of the patient, the need to preserve the uterus or not, etc.
Where do we treat it?
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