Welcome to the Northampton Pelvic Floor Clinic.

There is wide range of treatment options including non-surgical and surgical treatment. Surgeries can be performed without using meshes.

What is Genitourinary Prolapse?

Genitourinary prolapse results into protrusion of vaginal walls and/or uterus. It occurs when there is descent of one or more of the pelvic organs including the uterus, bladder, rectum, small or large bowel, or vaginal vault. The front (anterior) and/or back (posterior) walls of the vagina, the uterus and/or the top of the vagina (Vaginal Vault) can all be affected by this descent. It is usually accompanied by urinary, bowel, sexual, or pelvic symptoms.

Pathophysiology

The pelvic organs are mainly supported by the muscles of the pelvic floor and a connective tissue network connecting the organs to the pelvic muscles and bones (the endopelvic fascia). This support structure is weakened through direct muscle trauma, neuropathic injury, and disruption or stretching due to number of reasons.

Evaluation

Evaluation of prolapse involves detailed history taking to understand your symptoms and bother that it causes. It is important to determine your main symptoms and the effect of these on your daily life.

Specifically designed symptoms and quality of life questionnaire are used to determine this.

The examination to determine the extent of prolapse is required in both standing and lying on your back or onto your side. If there are bowel symptoms, rectal examination can be helpful. Specific investigations like ultrasound scans and Urodynamics (Bladder pressure studies) are required in certain situations.

Treatment

Treatment is required only if Prolapse is causing symptoms that affects your quality of life. The options range from quite simple treatment like Pelvic floor exercises or insertion of vaginal pessaries to surgeries. The surgical treatment is possible through vaginal, abdominal or key hole approach. Commonly offered surgeries are vaginal hysterectomy, anterior and/or posterior colporrhaphy, sacrocolpopexy, sacrospinous fixation and mesh surgery. The choice and extent of surgery depends on extent and type of prolapse, your preference, previous surgeries and other conditions.

If you wish to discuss further, please contact us.

As pelvic floor supports bladder, vagina as well as bowel, it is no surprise that women with pelvic organ prolapse often experience bowel symptoms. These symptoms may or may not be related to the vaginal prolapse. The classical bowel symptoms experienced include:

• Obstructed defaecation
• Faecal incontinence
• Constipation

Obstructed defecation

Many women with vaginal prolapse also have difficulty with complete bowel evacuation. This may manifest as sensation of incomplete bowel evacuation where the faeces may become trapped in the rectocoele (bowel prolapse into the vagina).

Due to incomplete evacuation, there is the need for repeated evacuation to empty bowels. Some women have to apply pressure on the perineum (area between the vagina and rectum), into the vagina or inside the rectum to complete evacuation of the lower bowel. If you have a vaginal prolapse, it is highly likely that a posterior vaginal repair is very likely to be effective in correcting the faeces being entrapped in the rectocele. There are women who have similar symptoms without a vaginal prolapse (rectocoele). These women do require further investigations to exclude a rectal prolapse as a cause of the symptoms. There could be other causes especially like rectal mucosal prolapse or anal intussusception which may give similar symptoms.

Faecal Incontinence

Approximately 4% of women who have given birth experience faecal incontinence. About 10% of women with vaginal prolapse experience faecal incontinence and generally the bowel leakage is not related to the vaginal prolapse. Causes of faecal incontinence include;

• External anal sphincter defect
• Nerve damage to the pelvic floor (Pudendal nerve Neuropathy)
• Rectal prolapse (complete rectal prolapse shown occurring with uterine procidentia

While defects of the external sphincter maybe detected on rectal examination investigations including endoanal ultrasound, nerve studies and or imaging will help differentiate between the various causes. We would work with a colorectal surgeon when required to correct these problems.

Constipation

Chronic constipation is define as infrequent bowel movements or difficult passage of stools that persists for several weeks or longer and is defined as having fewer than three bowel movements a week. It causes hard and lumpy stool which can alternate with diarrhoea (called overflow), need to strain to evacuate.

Constipation is more likely to be related to prolonged and slow transit of the faeces through the bowel and is not caused by vaginal prolapse but if untreated for long time, it can increase the risk of developing vaginal prolapse. It is related to amount of fluid and type of food you consume. It can give symptoms like bloating and increased wind.

There are simple measures to be taken to address constipation but in some cases it may require more invasive treatment.