Genital Prolapse

What it is

Genital prolapse is the descent of the bladder, uterus or rectum toward the vagina, caused by weakening of the muscles and ligaments that support the pelvic organs. It is more common after vaginal deliveries, with aging, during menopause and in women with excess weight, chronic constipation or who perform intense physical exertion. Symptoms vary with the degree of prolapse: a sensation of heaviness or a "bulge" in the vagina, mainly at the end of the day, difficulty urinating or having a bowel movement, urine leakage, recurrent urinary infections and discomfort during intercourse. Many mild prolapses do not require surgery. The urogynecological assessment defines the type and degree, and treatment may include pelvic floor physical therapy, vaginal estrogen during menopause, use of a pessary and, in cases with significant symptoms, corrective surgery.

Most common symptoms

• A feeling of heaviness or a bulge in the vagina, worse at the end of the day
• A visible or palpable bulge at the vaginal entrance
• Difficulty urinating or emptying the bladder completely
• Difficulty having a bowel movement or needing to support the vagina to do so
• Urine leakage or recurrent urinary infections
• Discomfort or pain during intercourse
• Low back pain or pelvic discomfort that improves when lying down

Causes and risk factors

• Vaginal deliveries, especially multiple ones or with large babies
• Aging and menopause, with loss of tissue support
• Excess weight and chronic constipation
• Intense, repetitive physical exertion, such as heavy lifting
• Chronic cough, as in smoking and respiratory diseases
• Previous hysterectomy and family predisposition

How it is diagnosed

During the consultation, your gynecologist listens to complaints of heaviness, bulging and urinary or bowel changes, and asks about deliveries, surgeries and habits. The gynecological exam is performed at rest and during straining, to identify which organ has descended — the bladder, the uterus or the rectum — and to what degree, as well as to assess pelvic floor strength and urine leakage. Urinalysis, ultrasound and other tests may be requested depending on associated symptoms.

How we treat it at Femi Saúde

Many mild prolapses do not require surgery. The gynecology team at Femi Saúde guides lifestyle changes, such as managing weight and constipation and being careful with straining, and recommends pelvic floor physical therapy to strengthen support. During menopause, vaginal estrogen improves tissue quality and urinary symptoms. A pessary, a device placed in the vagina to support the organs, is an alternative for those who do not wish to or cannot have surgery. In cases with significant symptoms or advanced prolapse, corrective surgery is indicated and planned according to the type of prolapse, the patient's age and her goals. The plan is individualized.

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