Genitourinary Prolapse

Genitourinary Prolapse

The term "genitourinary prolapse" refers to a condition in which one or more pelvic organs, such as the uterus, bladder, rectum, small or large intestine, or vaginal vault, protrude below the pelvic floor. In women, genitourinary prolapse develops when the pelvic floor muscles become weak and the genitourinary organs slip out of their usual supporting structures.

Types of Genitourinary prolapse:

• Anterior prolapse:
  • there can be prolapse of the urethra into the vagina.
• Posterior prolapse:
  • there can be prolapse of the back passage into the vagina.
• Middle prolapse:
  • there can be prolapse of the womb into the vagina.

Risk factors for prolapse:

• Childbirth:
  • The ligaments, nerves, and muscles around the vagina are stretched to their limits during normal birth. The stretching may weaken and destabilize the pelvic floor muscles.
• Increasing age:
  • After menopause, the vaginal supporting structures and the muscles of the pelvic floor become less elastic and supportive because of the loss of I oestrogen hormone.
• Increased pressure inside the abdomen
• Gynaecological surgery:
  • GU prolapse is more common in women who have had gynaecological surgery, such as a hysterectomy or vaginal birth control implant.

Symptoms:

Urinary symptoms:

`Urinary symptoms may be present if prolapse affects the front part of the pelvis. Symptoms may include:

• The need to pass urine often, both during the day and at night.
• Leaking of urine on coughing, sneezing, laughing, straining or lifting
• Feeling the sudden urge to pass urine, also sometimes leaking urine before getting to the toilet.
• A feeling that your bladder has not emptied properly and the need to pass urine again soon afterwards.
• The need to change position whilst sitting on the toilet or the need to use your fingers to push back the prolapse to enable the urine to pass.

Also, complications may occur. This include:

• Urine infection
• Loss of control of urine
• Retention of urine
• Bowel symptoms:
• Difficulty passing stools and having to strain into pass stools.
• Feeling a sudden urge to pass stools
• A feeling that your bowels have not emptied fully
• Incontinence of stools
• Passing lots of wind
• A feeling of a blockage or an obstruction while passing stools.
• Other symptoms:
  • If the prolapse is large enough to protrude from a vagina, this can lead to ulceration of the neck of the womb or skin. It may sometimes cause bleeding and infection.

Management:

• Watchful waiting:
  • Watchful waiting is an option if the symptoms are mild after discussing it with a doctor. If, however, any new symptoms emerge, medical attention must be sought immediately.
• Lifestyle changes:
  • For overweight, it may help if you lose weight
  • If a patient is constipated she should discuss this with a doctor to ensure that she is receiving adequate treatment.
  • Coughing can make prolapse worse. If the patient smokes, she should try to give up.
  • Avoid heavy lifting, as this may make prolapse worse.
• Pelvic floor exercise
• A vaginal pessary
• Vaginal oestrogen creams
• Surgery:
  • A vaginal repair operation
  • Removal of the uterus (a hysterectomy)
  • An operation to lift up the uterus and vagina such as sacrohysteropexy, sacrocolpopexy, Infracoccygeal hysteropexy or colpopexy, sacrospinous fixation.

Prevention:

• For an overweight, try to lose weight
• Eat high fibre diet and drink plenty of water to avoid constipation
• Stop smoking
• Avoid occupations that involve heavy lifting