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Prolapse

What and Why? 

Prolapse describes not one condition but a whole family of them — any in which an organ or part of your body has slipped out of its normal position, even though it remains attached to the same structures as usual. It can only happen if these attachments get stretched or slack, and usually applies to organs in the lower abdomen or pelvis.

 

Pelvic prolapse

Women are particularly vulnerable to prolapse. The female pelvis cannot be rigidly closed but must be capable of stretching open to a diameter of 10cms for childbirth to be possible. Even if you never have a child, any other stresses on the muscles and ligaments that support and surround your vagina and womb tend to push them downwards and forwards, towards the outside.

Normal childbirth need not add to these; in fact the natural forces that push the baby out actually tend to pull the womb and vagina upwards, opposing any tendency to prolapse. However, prolonged voluntary pushing to reinforce labour contractions tends to undo this benefit: so does any form of assistance by the midwife or doctor (forceps, for example). Tearing or surgical cutting (episiotomy) of the muscle around the outlet usually heals very well but there is always some scarring, with the possibility of weakness if the repair is not tight enough.

Although prolapse affects women almost exclusively on account of these peculiarly female risk factors, they cannot alone be directly responsible nowadays for many cases of prolapse — maternity hospital surgeons and physiotherapists are too well aware of the risk. The real culprit is much more likely to be something that affects the victim not just for a few hours of her life, nor even a few months, but every day. Lifting is unlikely to qualify: if the effort makes you strain, you automatically tighten the muscles under your bottom as well, protecting yourself. The chief suspect has to be the kind of low-level constipation (see constipation) that not only obliges you to strain every day in order to pass a bowel motion but also calls for relaxation of the muscles of your bottom to let it out. Unfortunately you cannot keep your vagina tight at the same time, so straining in these circumstances is bound to stretch it and push your womb down into it, in just the same way as it causes piles in either sex (see piles).

Two other organs besides your womb are well placed to gape into your vagina: your bladder, which lies in front; and the last few inches of your bowel, which lies behind. These hollow structures sometimes pout into the lowest part of your vagina like balloons: with the tip of a finger placed just inside your vagina, you may be able to feel this happening while you strain gently. If your bladder pouts (surgeons call this cystocoele) you will find sooner or later that you cannot so reliably prevent it from leaking (see embarrassing leaks): a pouting bowel (rectocoele) can have the opposite effect, of increasing the mechanical difficulties of constipation.

Bowel and Bladder Prolapse

Bowel and bladder prolapse are now the most common forms, and can affect quite young women. Apart from the effects of constipation and childbirth, hysterectomy (see hysterectomy) sometimes introduces a weakness which makes one or both of these consequences more likely. On the other hand severe prolapse of the womb is now rare although it still occasionally occurs in very elderly ladies, with the cervix sometimes showing at the outside as an alarming lump.

Once prolapse has occurred in any pronounced degree it weakens the muscles surrounding it so much that attempts to recondition them and heal the prolapse naturally are unlikely to be successful. Surgical repair by a gynaecologist may then be the only sensible course in the short run, but you must also correct the on-going tendency which exposed the weakness or it is liable to recur.

What can I do?

Advice to maintain and maximise your health

1. Maintain good habits: Take your bowel habit seriously (see piles). It should never be necessary to strain in order to empty your bowel. If you do, even on only a few days each week, you risk progressively weakening all the structures involved and eventually prolapsing one or all of them. See to it first of all that your diet is right (see food for health); use the brose recipe (see recipes for health) to increase its fibre content if you really cannot take lots of vegetables. If you still have to strain, try taking one or two tablets of Betaine Hydrochloride (Nature’s Best, Lambert’s Road, Tunbridge Wells, Kent) with each meal, but not enough to cause indigestion (see indigestion). Avoid using laxative tablets if at all possible.

2. Practice pelvic floor exercises: Cultivate the habit of tightening and relaxing the muscles around your vagina, as if you wanted to stop your urine flowing in mid-stream. This is something you can usefully do many times a day — at the sink, in the car, waiting in queues. The more you do it the stronger it gets. Make sure that you do not strain involuntarily at the same time — regular breathing throughout the exercise helps to prevent that.

3. If you put on weight, admit it — do not wear tight corsets or belts to conceal it. Pressure from clothing increases the tendency to hiatus hernia (see hernia) and varicose veins (see varicose veins) as well as prolapse. By all means take overweight seriously, but deal with it honestly (see overweight).

4. Childbirth: During your last few months of pregnancy before childbirth, work regularly on stretching the entrance of your vagina to make it as elastic as possible. During labour, take your time as the baby’s head passes through; don’t be hurried. It pays to tell your midwife your intention early on in the labour, while you have time (see giving birth).

Resume the muscle tightening exercise (2 above) as soon after childbirth as possible — usually within 12 hours. Unless you work at this, each baby you have normally will weaken your control of these muscles a little more.

5. Sugery preparation: If you face the prospect of surgical repair (see surgery) or hysterectomy (see hysterectomy), prepare deliberately for this. Get accustomed to the muscle strengthening exercise beforehand, while it is comfortable: it will be sore for several weeks after the operation and you must be ready to overcome this. Regular daily use of cold water in douches, a bidet or a Sitz bath (see bathing) will help your recovery.

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