Organ prolapse and incontinence in women

What factors contribute to prolapse?

Genital prolapse is usually caused by a combination of factors. The following factors frequently contribute to the development of genital prolapse:

• Multiple pregnancies and difficult vaginal deliveries can weaken or stretch some of the pelvic support and maintenance structures.

• Menopause is a second key factor. Indeed, during this period, a deficiency in estrogen gradually develops, leading to a weakening of the perineum and a feeling of heaviness.

• Situations that promote significant pressure on the pelvic organs (chronic cough, chronic constipation, the way heavy loads are carried, obesity, sedentary lifestyle);

• Genetic factors

• The presence of any injuries - for example those that could occur during a hysterectomy (removal of the uterus), or any other surgical procedures in the pelvic region.

What are the symptoms of a “prolapsed organ”?

Prolapse is sometimes discovered by chance during a gynaecological clinical examination when it is not yet causing any symptoms.

Symptoms tend to appear when the woman is standing and disappear when she is lying down and resting.

Regardless of the organ(s) affected, the most common symptom is a sensation of a lump or discomfort in the vagina , sometimes associated with:

• urinary problems (recurrent infections, difficulty urinating, urinary leakage, urgent and frequent need to urinate);

• anorectal disorders (constipation, faecal incontinence);

• sexual or vaginal disorders (discomfort or pain during intercourse).

Organ prolapse can precipitate urinary incontinence or serve as an aggravating factor. As the organs slip down, they exert pressure on the bladder. The sphincters are no longer functioning properly, leading to urine leakage.

What are the possible treatments?

The natural progression of prolapse is slow over time. Treatments aim to maintain the prolapsed organs in place and/or address associated problems (urinary, anorectal, and sexual dysfunction) in order to improve the patient's quality of life.

There are two types of treatment: conservative treatments, meaning without surgery, and surgical treatments. These treatments are accompanied by lifestyle recommendations to help slow the progression of the prolapse and prevent recurrence. You will therefore be advised to:

• Monitor your weight and prioritise good eating habits;

• treat chronic constipation;

• better manage straining efforts when using the toilet and when coughing;

• better manage how loads are carried;

• to engage in gentle physical activity.

The treatment of genital prolapse depends on several criteria: the severity of the woman's symptoms and her ability or inability to undergo invasive surgery.

Conservative treatments

Conservative measures are sufficient if symptoms are mild or if surgery is contraindicated. Insertion of a pessary and/or pelvic floor muscle rehabilitation are the first-line treatments. If these prove insufficient, surgery may be considered.

A pessary is a medical device made of latex or silicone that is inserted into the vagina to support the pelvic organs (bladder, rectum, uterus). It can be used continuously or occasionally. Pessaries come in various shapes (ring, cube, doughnut, etc.). Your doctor, midwife, or physiotherapist will help you determine the right model for you. This device can provide rapid relief from symptoms.

Pelvic floor rehabilitation is an effective preventive and therapeutic solution. Performed by a specialised physiotherapist or midwife, it aims to strengthen the pelvic floor muscles and slow the progression of genital prolapse.

Surgical treatments

When patients do not wish to use a pessary or when their symptoms become very debilitating, surgery remains an option, provided there are no contraindications. Surgery requires that risk factors be addressed (such as being overweight).

The aim of the intervention is to correctly reposition the bladder, vagina, uterus, and rectum in the pelvis and to compensate for pelvic floor deficiencies by supporting or suspending the organs from nearby stable pelvic structures (bones or ligaments).

Depending on the patient's age, health status and choice, the surgeon will operate via the abdomen (most often by laparoscopy) or via the vagina .

Patients can then gradually resume normal physical activity. However, lifting heavy loads must be strictly avoided for 6 weeks.

Prolapse and Incontinence

The sensations of heaviness, pain, and urinary incontinence associated with pelvic organ prolapse can disrupt your various activities. Reduce the impact of prolapse on your quality of life by following a few simple rules: manage your urinary incontinence more easily by wearing appropriate incontinence products, adopt a healthy lifestyle, and regularly engage in activities that strengthen your pelvic floor muscles.