Prolapse is a condition where the vaginal muscle layer has become weakened or torn (usually after childbirth) and bowel at the back or bladder at the front pushes into the vagina making a bulge. Sometimes the supports to the womb (or top of the vagina after hysterectomy) weaken and the drop down into the vagina and occasionally protrudes outside the opening of the vagina. Depending on the severity of the condition and your wishes, Olivia can discuss with you the options of treatment of this uncomfortable condition. In the first instance for milder prolapses, pelvic floor exercises or toners will be recommended or you may be offered a support pessary (a plastic device fitted in the vagina) especially if you do not wish to have an operation. Once fitted – you won’t know the pessary is there. It can take a bit of trail and error to find the most suitable pessary for you and it doesn’t suit all women. Support pessaries require ongoing care with check ups every 4 to 6 months and most insurance companies will not pay for longterm management of pessaries. The check ups are necessary to ensure the presence of the pessary is not rubbing on the vagina and causing sore patches. It is often necessary to use vaginal estrogen preparations to keep the skin of the vagina in good condition and make it more resistant to sore patches. It is possible to remove ring -type pessaries for intercourse or just leave it in during intercourse. Other types of pessary mean that it is not possible to have sex.
Alternatively you may prefer a surgical repair to correct the prolapse. Depending on the type of prolapse you have you may need a repair of the front wall or back wall of he vagina and sometimes a vaginal hysterectomy.
If you have had a recurrence of a prolapse in the same part of the vagina that has been repaired before, you may need to see a urogynaecology specialist instead of Olivia who may offer a different type of specialist repair or offer a mesh repair. If your symptoms are only of urinary stress incontinence, a urogynaecologist would be better placed to offer you surgical intervention (TVT, urethral bulkamid injection or colposuspension).
Olivia is not able to help you if you are having problems with a previous mesh or TVT – please see a subspecialist urogynaecologist for this.