Prolapse is when gravity pulls down an organ or part of an organ as a result of the release of its means of fixity. Genital prolapse involves the pelvic organs like the uterus, bladder and rectum. It is a common disease in older women.
A BIT OF VOCABULARY:
-Cystocele:it is a bladder prolapse . This occurs when the bladder wall pushes into the vagina. -Hysterocele: it is a uterine prolapse.-RECTCELE It is rectal prolapse .This occurs when the rectum pushes into the vagina.
The risk factors are:
The main risk factors are:-multiparity-menopause (hormone deficiency) causing atrophy of supporting tissues-the vaginal delivery of child macrosomia (weight above normal)-births by instrumental extraction (spatulas, forceps)-deliveries by obstetric maneuvers-obesity-chronic constipation and former because of increased abdominal pressure-history of pelvic surgery.
DIAGNOSIS:
The diagnosis is mainly clinical. During the consultation, the patient is examined initially in the gynecological position, full bladder at rest and during exertion of pressure (eg cough). In a second step, the patient is examined standing. Thus, this comprehensive rexamination can:-diagnose the prolapse-specify the type of prolapse and anatomical structures involved-search for associated stress urinary incontinence.Note that a prolapse can be of one, several or all 3 floors of the perineum. Some additional tests should be performed as a pelvic ultrasound will evaluate the uterine volume and seek a pathology of the uterus or ovaries and uro-dynamic balance that will search and identify potential associated urinary problems After this initial treatment, we will be able to specify the stage of prolapse:-STAGE 1: intravaginal prolapse-STAGE 2:lower part of vagina prolapse-STAGE 3: extra-vulvar prolapse
TREATMENT :
It depends on the discomfort, associated disorders including urinary, age and general condition of the patient.There is no urgency to treat genital prolapse. It is a functional pathology. Also, no treatment is necessary in an elderly woman, with an old prolapse which is well tolerated.Otherwise, there are 2 types of treatment: :-Medical Treatment: :-The dietary guidelines: the fight against obesity, regulation of transit, lifestyle -Hormone replacement therapy (in the absence of contraindications) that will allow a struggle against the atrophy of muscle and mucocutaneous-Pelvi-perineal re-education which will strengthen the perineal floor muscles-Surgical treatment: :-A prolapse under general anesthesia can be performed in the operating room.
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Victor Hugo