Causes of prolapse

In some women, if the muscles supporting the womb are naturally weak or have become weakened through childbirth, particularly if labour was lengthy or the baby large, the womb or part of it may drop into the vagina. This is called a prolapse (which means’falling through’).

Tends to occur more often in the 30-plus age group than in younger women, especially after the menopause when the muscles lose their elasticity because of hormonal changes.

In the past, women were often left for hours in the second stage of labour with the baby’s head pushing into the vagina. The result was flabby, devitalized muscles around a stretched vagina and damaged womb supports, making a subsequent prolapse almost inevitable. To help deliver a baby which is otherwise going to take over two hours, doctors nowadays often perform an episiotomy, a small cut in healthy muscles which can easily be repaired and quickly returns to normal.

How to prevent prolapse

The best preventive measure for prolapse is to do the post-natal exercises that get the vaginal muscles back into shape. Often after a second baby, you feel you really haven’t got the time to bother with them, but it is worth it You need to squeeze and relax the muscles in the base of the pelvis up to 100 times, as many times a day as possible. The exercises can be done while watching television or waiting for a bus, so you shouldn’t need too much will power to do them.

If the muscles of the pelvic floor are weakening, the first sign is usually’stress incontinence’. Urine leaks from the bladder when pressure inside the abdomen is increased by coughing, sneezing, laughing or running.

This can be treated by special exercises under the guidance of a physiotherapist. Done regularly, they not only secure the incontinence, but can prevent a prolapse.

What does a prolapse feel like?

As the womb drops, it may pull on the ligaments attached to the lower part of the back bone, resulting in a dull ache or a dragging sensation in the lower abdomen, as if something was trying to get out between your legs. Some women describe it as being like a baby s head waiting to be pushed out. The womb can also drag the back of the bladder down and cause problems of incontinence later on. ‘) By die time the symptoms of prolapse appear, surgery is the best treatment. Women who don’t want any more children, usually have a hysterectomy. The operation is done through the vagina, so there’s no scar, and at the same time a tuck is made in the skin on the front and back walls of the vagina and the underlying muscles are tightened.

Ifvou want more children it is possible to do the repair to the vagina only and to leave the womb. Since another full scale labour is likely to undo the repair the baby will usually be delivered by Caesarean section before labour starts. Even if you don’t become pregnant the womb may pull down again, so the repair operation may not be a permanent cure. Where surgery isn’t suitable the alternative is to insert a hard rubber ring, a pessary, which hitches up the womb by supporting it at the top or the vagina The ring does, however, have to be changed every few months for reasons of hvgiene.