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Prolapse. Mr Khaled Farag, Consultant Gynaecologist answers the Top FAQs


Mr Khaled Farag, Consultant Gynaecologist
Claremont Clinics: Monday AM, Friday EVE, Saturday AM


What is Prolapse?

Prolapse (from Latin Prolapsus, a slipping forth) refers to the falling or slipping out of place of a part or viscus.

Prolapse is a hernia of the vagina that women feel as a bulge or pressure.  This is referred to in many different ways, sometimes called a ‘dropped vagina’, ‘dropped bladder’ ‘dropped womb’or ‘dropped rectum’.  Your doctor may have also called this a cystocele or rectocele.

The pelvic floor muscles are a group of muscles at the base of your pelvis that support the vagina, womb, bladder and bowel.  When the pelvic floor muscles weaken or stretch, a prolapse can occur.  This is where one or more of the organs within your pelvis lacks support and drops down.


What Types of Prolapse are there?

  • Cystocele - Anterior/front/bladder prolapse
  • Rectocele - Posterior/back/bowel prolapse
  • Uterine Prolapse - Prolapse of the womb
  • Vault Prolapse - Prolapse of the top of the vagina after hysterectomy

Woman may have more than one of these types of prolapse.


What are the Symptoms of Prolapse?

Your symptoms will depend on what type of prolapse you have.  Symptoms can include the following;

  • Awareness of a "bulge" or "something coming down"
  • Feeling of fullness or heaviness in the pelvic organs
  • A pulling or aching feeling in the lower abdomen or pelvis
  • Painful or uncomfortable sex
  • Difficulty urinating or defecating


What are the Treatment Options?

Pelvic organ prolapse unfortunately will not get better without treatment.  The first thing your doctor will recommend are pelvic floor exercises and possibly a pessary which is a removable device placed in the upper part of the vagina to support the pelvic organ.  Pessaries do not cure prolapse, but can help relieve symptoms and keep the prolapse in place.

The next treatment stage is surgery.  
 

When Should I Consider Surgery to Treat Pelvic Organ Prolapse?

If your symptoms are severe and disrupt your life, and non-surgical treatment options have not helped you, you may want to consider surgery.
 

What Factors Should I Consider when Deciding Whether to Have Surgery?

  • Your age.  If you have surgery at a young age, there is a chance that prolapse will recur and possibly require additional treatment.
  • Your childbearing plans.  Women planning to have children or more children should postpone surgery until their families are complete, to avoid the risk of prolapse happening again.


What Types of Surgery are there for Pelvic Organ Prolapse?

In general, the majority of prolapse surgeries are performed via the vagina.  This means there are no surgical incisions (cuts) made on the abdomen (tummy).

Usually the surgeries are reconstructive, which means it reconstructs the pelvic floor with the goal of restoring the organs to their original position.  There are different types of reconstructive surgery depending on the type of prolapse.


Do I have to have a Hysterectomy as a part of my Surgery?

No, only if the there is a significant womb prolapse.  Whether or not to remove the uterus should be discussed between the patient and the surgeon, and the decision is individual from patient to patient.


What is Involved in Recovery after Surgery?

Some vaginal bleeding may occur during the first week or so.  Your vaginal loss should change to a creamy discharge over the next 2-3 weeks, this is quite normal.  DO NOT USE TAMPONS.

Timescales for Recovery

  • Do not drive an automatic car for 1 week
  • Do not drive a manual car for 2 weeks
  • Do not make a bed for 2 weeks
  • Do not take a bath but instead take a shower for 2 weeks
  • Do not squat to do the washing or hang washing out for 4 weeks
  • Do not use vaginal oestrogen for 4 weeks
  • Do not stretch upwards for 6 weeks
  • Do not do any lifting for 6 weeks
  • Do not have sexual intercourse for 6 weeks


Remember to rest, if you are tired and uncomfortable you have been doing too much and need to slow down. Swimming is an excellent way to keep you active and this may be resumed after 2 weeks.  

When emptying your bladder, sit on the toilet, feet flat and lean forwards.  Please ensure that you empty your bladder every 3 hours during the daytime and drink 6-8 glasses of fluid per day.  Limit your caffeinated drinks to 3 per day and ensure your fibre intake is 30g per day.  If constipation is a problem, Lactulose, which you can buy from the chemist or another stool softener should be used.


Patients who follow the recommended restrictions after surgery give themselves the best chance for permanent success.


How Successful is Surgery for Pelvic Organ Prolapse?

The aim of pelvic reconstructive surgery is to re-create normal anatomy permanently.  However, none of these procedures are 100% successful.  According to the medical literature, failures occur in 5-15% of women who have prolapse surgery.

Many factors affect the outcome of reconstructive surgery.  Some of the factors that originally contributed to your pelvic floor problems, such as decrease muscle and nerve function and weak connective tissue, may still exist after the reconstructive procedure has been performed.

To increase the success rates simple measures to be followed are:

  • Lose weight if overweight
  • Reduce or quit smoking
  • Treat conditions that might put strain on the pelvic floor, such as a chronic cough or constipation
  • Improve pelvic muscle tone by doing pelvic muscle exercises and continuing to do them after surgery.  


Is there a Place for Surgery if I have Recurrent Prolapse Post-Surgery?

Yes.  However, you should be seen and assessed by a Gynecologist specialising in this area.


Private Patient Prolapse Surgery Testimonials

Mrs B, from Sheffield says "Mr Farag is without doubt the nicest doctor I've ever seen. He showed courtesy and was so caring, sensitive and efficient. I have had experience of many private hospitals and Claremont is by far the best - the only hospital to offer a panini with afternoon tea! I would recommend Mr Farag and Claremont to anyone."

JB from Worksop says "Mr Farag is a perfect gentleman, in whom I have complete confidence. He made me feel safe and confident every step of the way explaining all the details to me in a way I could understand. I had no anxiety even though it was a major operation. I had total confidence in Mr Farag and being at Claremont was a wonderful experience - 10 times better than anywhere else I've been for surgery."

Mrs J from Chesterfield says "I've never been in hospital for an operation before and I won’t be scared ever again.  Mr Farag gave me all the options and the whys and wherefores in a clear way I could understand, he was just fantastic. He is the best consultant I have ever met.

Everyone was wonderful, the nurses, Sue in housekeeping, the anaesthetist – everyone was really positive.

I have no hesitation in recommending Mr Farag or Claremont. Infact, I already have and they are coming in for an appointment. It was a brilliant first experience."

 

A private consultation with Mr Farag at Claremont is £160 if you don't have health insurance.  To book an appointment, call our friendly Private Patient Team on 0114 263 2114 or email privatepatients@claremont-hospital.co.uk.  You will need a referral letter from your GP or you can see one of our Private GPs if you prefer.

Copyright Khaled Farag, 2016.

Date: 20/04/2016
By: Laura Penn
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