Pelvic floor prolapse is basically divided into three stages;
1. The uterine cervix descends but does not reach the vagina.
2. The cervix appears at the vaginal orifice but protrudes only on straining.
3. The uterus lies outside the vulva; this kind of prolapse is known as Procidentia.
The pelvic floor consists of a muscular diaphragm, which is formed by the levatorani muscles; the medial edges of the levator muscles form the lateral boundaries of the urogenital aperture. The vagina and the urethra pop through this opening. Although the pelvic floor may be said to support the pelvic organs, it does so indirectly. The perennial body supports the posterior vaginal wall. Deficiency of perennial body causes widening or laxity of the pelvic floor aperture, but this doesn’t necessarily lead to pelvic floor prolapse.
Nearly all women suffering from pelvic floor prolapse have borne children. Pelvic floor prolapse is almost invariably the result of damage to the supporting structures during childbirth, yet in many cases pelvic floor prolapse doesn’t become troublesome until after the menopause, when some degree of atrophic changes start to occur. Occasionally, interovaginal prolapse is seen in a nulliparous woman after menopause, when congenital weakness of the supporting structures is thought to be present.
Obstetric factors are particularly important in the development of pelvic floor prolapse. If a woman pushes down before full dilation of the cervix or if forceps or the Venotouse are employed in the final stage of labor, the cervix maybe damaged or the ligaments maybe over stretched leading to pelvic floor prolapse. Prolonged labor or delivery of a large fetus increases the likelihood of damage. Episiotomy maybe helpful in avoiding perennial damage as it prevents over stretching.
Postmenopausal atrophy is one of the leading causes of pelvic floor prolapse. Chronic constipation, persistent cough, heavy weight lifting and large inter abdominal mass may be contributory factors in cases of pelvic floor prolapse. Vaginal discomfort, dragging and the sensation of something coming down results from the prolapsed part bulging into the vagina and eventually protruding through the vaginal opening. Back ache due to prolapse is worsened if you stand for extended periods of time, as then gravity also plays a major role in pulling the pelvic organs down. The pressure of the pelvic organs and back ache is relieved when the patient lies down. In some patients the frequency of micturition and stress incoherence is also seen. Women with a significant pelvic floor prolapse may complain of dyspareunia along with interaction and bleeding of exposed surface.
Diagnosis of pelvic floor prolapse may be obvious in inspecting the vulva with patient lying on her back and straining down. Pelvic floor prolapse maybe prevented by pelvic floor exercises antenatally, these exercises are very easy to do. They can be done anywhere and at any time. Pelvic floor exercises are also called Kegel exercises. The main purpose of these exercises is to strengthen the pelvic floor. The steps of these exercises are fairly simple you have to contract your pelvic floor muscles, the action is similar to trying not to urinate. When you have contracted or lifted up your pelvic muscles hold your position and count up to five and then slowly relax your muscles. A very important thing to remember while doing these exercises is to breathe normally, when you have contracted your muscles don’t stop breathing instead breathe calmly as this is the only way to get the full benefits of Kegel exercises.
Postmenopausal women may benefit from estrogen replacement therapy. Prolapse which causes a lot of discomfort should be treated surgically, but surgery is not a good option if;
• The woman intends to have another baby in the near future.
• The woman is too old or too ill for the operation.
• The woman doesn’t wish to undergo this procedure.
Pelvic floor prolapse is a serious medical condition and it should be treated immediately.