Genital organ prolapse refers to the prolapse of vaginal anterior wall adjacent to the bladder together with bladder, uterus and/or last portion of the large intestine adjacent to the posterior vaginal wall out of vagina. The prolapsed part usually pulls down the other parts of the vagina, causing in these areas as well.
What are the causes?
The most important causes of genital organ prolapse are delivery-related causes. The pelvic supportive tissue is damaged in many cases such as multiple delivery, difficult delivery, giving birth to a big baby, delivery with intervention (vacuum, forceps). Accordingly, prolapse occurs.
Moreover, chronic lung diseases (COPD, asthma, and bronchitis), obesity, constipation, heavy works, genetic predisposition and connective tissue weakness are other causes.
What is the incidence?
It varies depending on countries and the number of deliveries. The rate is high in our country where fertility rate is high. More than half of women who had deliver experience ganital prolapse to varying extents.
What is its finding? What complaints are seen?
The finding of genital prolapse is palpable mass in the vagina. The patient may first have urinary incontinence. In the advanced stages, on the contrary, the patient may have difficulty in urinating. Even, the patient can urinate by pushing the anterior wall of the vagina upwards using the fingers. If the last portion of the large intestine also prolapses, the patient cannot comfortably defecate, has constipation and can defecate by manually pushing on the posterior wall of the vagina. In advanced cases, renal functions also deteriorate.
Another important question in genital prolapse is the decrease in the quality of sexual intercourse due to the enlarged or prolapse of the vagina. A woman cannot enjoy sexual intercourse as it used to be. In the same way, her partner has similar displeasure.
What is the treatment?
The treatment of genital prolapse is mainly surgery. Rings made of silicone, called pessaries, are used in elderly patients who cannot undergo surgery. These rings are required to be removed and cleaned at regular intervals.
There have been innovations in the treatment of genital prolapse with the development of medicine and technology. In the past, the success rates were low and surgeries requiring long-term hospitalizations were performed. Today, medical fabrics in the form of net, called mesh, are vaginally placed under the tissue, in addition to the current surgeries. In this way, the success rate has increased above 90%. Moreover, another new treatment method is robotic surgery. In robotic surgery, the vaginal vault is fixed to bone tissue at the back using mesh, if the uterus is removed with closed surgery. The success rate of this operation is also above 90%. In this operation, no large incision is made, bleeding, pain is less and the patient can return to work early.
In addition, the vagina is closed layer by layer in patients who do not have sexual intercourse (colpocleisis). This is also an effective method.
Patients with genital prolapse should be evaluated well and appropriate surgery should be performed. All prolapsed areas should be treated. Untreated areas cause prolapse of other areas after the surgery. The most effective surgery in this disease is the first surgery. Subsequent surgeries are both more difficult and more likely to cause recurrence.
Urinary incontinence coexisting with genital prolapse can also be corrected in the same session.
