Prof. Dr. Süleyman Salman

Genital prolapse is often associated with aging, childbirth, hormonal changes, and weakening of the pelvic floor muscles. Especially in women who have had multiple pregnancies, the pelvic floor muscles and ligaments can stretch and weaken during childbirth. This can significantly impact a woman's quality of life and lead to physical and psychological problems. Genital prolapse sometimes occurs alongside other health problems and can lead to complications if left untreated.

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Genital prolapse can occur in various types and severities. The most common types are uterine prolapse, vaginal wall prolapse, bladder prolapse (cystocele), rectal prolapse (rectocele), and uterine prolapse. These conditions can present with different symptoms related to the displacement of the pelvic organs.

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Uterine Prolapse: Uterine prolapse is a condition in which the uterus prolapses into or out of the vagina. This condition is often associated with weakened pelvic floor muscles and trauma experienced during childbirth. Women with uterine prolapse may experience a feeling of fullness in the vaginal area, pain, urinary incontinence, and sometimes a vaginal protrusion. In severe cases, the uterus may protrude entirely through the vagina. This can cause pain during intercourse and other discomfort. If left untreated, complications such as serious infections and urinary tract problems can develop.

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Vaginal Wall Prolapse (Cistocele and Rectocele): Vaginal wall prolapse is a condition where the pelvic organs press against the vaginal wall, creating a bulge within the vagina. This condition can be divided into two categories: bladder prolapse (cystocele) or rectal prolapse (rectocele). A cystocele is the prolapse of the bladder against the vaginal wall and can present with symptoms such as difficulty urinating, frequent urination, and urinary incontinence. A rectocele is the prolapse of the rectum against the vaginal wall and can cause symptoms such as straining during defecation, constipation, and a feeling of pressure in the vaginal area.

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Bladder Prolapse (Cystocele): A cystocele is the prolapse of the bladder against the vaginal wall. It typically develops due to damage to the pelvic floor muscles during childbirth and aging. Women with a cystocele may experience difficulty urinating, frequent urination, incontinence, and a feeling of fullness in the vaginal area. This condition can be exacerbated by factors such as prolonged constipation, excess weight, and heavy lifting.

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Rectum Prolapse (Rectocele): A rectocele is a condition in which the rectum prolapses toward the vaginal wall. This can cause symptoms such as straining during bowel movements, constipation, a feeling of pressure in the vaginal area, and sometimes fecal incontinence. A rectocele typically develops as a result of weakening of the pelvic floor during childbirth and can negatively impact quality of life if left untreated.

 

Symptoms of genital prolapse vary depending on the severity and type of prolapse, and which part of the pelvic organ is prolapsed. The most common symptoms include:

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A feeling of fullness or pressure in the vaginal area

Pain during sexual intercourse

Urinary incontinence or difficulty urinating

Frequent urination

Straining during defecation

Constipation

Pain or discomfort in the pelvic area

Vaginal bulge sensation (in cases of severe prolapse)

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Treatment for genital prolapse varies depending on the severity and type of prolapse, the woman's age and health, and the severity of symptoms. Genital prolapse treatment generally involves conservative approaches, surgery, or a combination of both.

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Conservative Treatment (Non-surgical Treatment)

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Conservative treatment methods are the preferred initial treatment for genital prolapse. These methods are used to strengthen the pelvic floor muscles and prevent prolapse. The most common conservative treatment options include:

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Pelvic Floor Exercises (Kegel Exercises): Strengthening the pelvic floor muscles can help prevent the progression of prolapse. Kegel exercises are simple exercises that involve contracting the vaginal muscles. Regular Kegel exercises can help support the pelvic organs and alleviate symptoms.

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​ Vaginal Pessary: A vaginal pessary is a device inserted into the vagina and is used to prevent prolapse of the pelvic organs. A pessary is typically used in cases where surgery is not recommended or in older women. This device helps keep the pelvic organs in place and relieves symptoms.

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Lifestyle Changes: Certain lifestyle changes may also be recommended to relieve symptoms of genital prolapse. Losing excess weight, preventing constipation, avoiding heavy lifting, and getting regular exercise can help strengthen the pelvic floor muscles.

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Surgical Treatment:

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If conservative treatment methods are insufficient or if the prolapse is severe, surgical intervention may be necessary. Surgical treatment varies depending on the type and severity of the prolapse and the patient's overall health. Surgery is generally performed to reposition the pelvic organs or increase pelvic floor support. Surgical methods may include:

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Pelvic Floor Repair Surgery: Surgical procedures to strengthen the pelvic floor muscles and place organs such as the uterus, vagina, bladder or rectum back in their original positions.

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Hysterectomy: Hysterectomy may be recommended in cases of severe uterine prolapse, particularly if the uterus is prolapsed. A hysterectomy is a surgical procedure to completely remove the uterus.

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Vaginal Reconstruction: These are surgical procedures performed to strengthen or reconstruct the vagina. This can be used in cases of vaginal prolapse and sagging.

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Genital prolapse treatment must be tailored to each individual and may require a different approach for each woman. Treatment should focus on the type of prolapse, the severity of symptoms, and the woman's quality of life. If left untreated, genital prolapse can lead to urinary tract infections, bowel problems, and more serious damage to the pelvic organs. Therefore, it is important for women experiencing symptoms of prolapse to consult a specialist without delay.