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Pelvic Prolapse
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Introduction
Pelvic prolapse is a condition in which pelvic organs including the uterus, vagina, bladder, urethra or the rectum descend, or fall out of their normal positions. Prolapse occurs due to several factors such vaginal delivery, age, hysterectomy, straining, obesity,Chronic constipation and family history. Without medical treatment or surgery, these structures may eventually prolapse farther eventually descending into the vagina or protrude beyond the vaginal opening and are visible or palpable outside the body. This is when the patient feels "something like a ball of tissue out of the vaginal opening."
The symptoms that result from vaginal prolapse commonly affect sexual functions and bodily functions such as urination and defecation. Pelvic pressure and discomfort are also common symptoms.
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Types of Vaginal Prolapse
Cystocele (bladder drop)
This can occur when the front wall of the vagina (anterior) prolapses. As a result, the bladder may prolapse into the vagina. When this condition occurs, the urethra usually prolapses as well. A urethral prolapse is also called a urethrocele. When both the bladder and urethra prolapse, this condition is known as a cystourethrocele. Urinary stress incontinence (urine leakage during coughing, sneezing, exercise, etc) is a common symptom of this condition.
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Rectocele (prolapse of the rectum)
Occurs when the back (posterior part) of the vagina and rectum are dropped.
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Enterocele
An enterocele results when your small intestine (small bowel) drops into the lower pelvic cavity and protrudes into your vagina, creating a bulge. An enterocele is a vaginal hernia. The weakening of the upper vaginal supports can cause this type of vaginal prolapse. This condition primarily occurs following a hysterectomy.
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Uterine Prolapse
Occurs when the uterus descends downwards caused by weakening of uterosacral ligaments at the top of the vagina. uterine prolapse has different stages:
  • First-degree prolapse: The uterus droops into the upper portion of the vagina.
  • Second-degree prolapse: The uterus falls into the lower part of the vagina
  • Third-degree prolapse: The cervix, which is located at the bottom of the uterus, sags to the vaginal opening and may protrude outside the body.
  • Fourth-degree prolapse: The entire uterus protrudes entirely outside the vagina.
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Vaginal Vault Prolapse
This type of prolapse may occur following a hysterectomy. the top of the vagina gradually falls toward the vaginal opening. This may cause the walls of the vagina to weaken as well. Eventually, the top of the vagina may protrude out of the body through the vaginal opening, effectively turning the vagina inside out. A vaginal vault prolapse often accompanies an enterocele.
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Treatment
there are different options to treat pelvic organ prolapse conditions.such as:
Non-surgical
Pessary use is the only non-surgical intervention for women with pelvic organ prolapse. This is an internal vaginal device, usually made of silicone, that supports the vaginal walls and to related pelvic structures it also relieves pressure on the bladder and bowel.
Surgical
Reconstructive surgery for prolapse aims to correct the prolapsed vagina while maintaining (or improving) vaginal sexual function and relieving any associated pelvic symptoms. Surgery can be undertaken by either an abdominal or vaginal route. Surgical repair of the prolapse typically requires a suspension of the vaginal wall.
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