Prolapse

Prolapse is a condition in which an organ or tissue falls from its normal position and protrudes into or through an adjacent structure. It most commonly involves pelvic organs, but the term can describe shifts in other parts of the body. Pelvic organ prolapse occurs when the pelvic floor muscles and ligaments are weakened, reducing support for the uterus, bladder, or rectum.

Common pelvic prolapses include uterine prolapse, vaginal vault prolapse after hysterectomy, cystocele (bladder bulge into the vagina), rectocele (rectal bulge into the vaginal wall), and rectal prolapse (the rectum protruding from the anus). Enterocele refers to small bowel protrusion into the vaginal space. Symptoms depend on the affected organ and may include a vaginal bulge or fullness, urinary symptoms, bowel problems, pelvic pressure, or discomfort with activity.

Risk factors include pregnancy and childbirth, ageing, obesity, chronic coughing or constipation, heavy lifting, prior pelvic surgery, and connective tissue disorders. Prolapse can be present without severe symptoms but may progress over time.

Diagnosis is made by medical history and a pelvic examination; imaging tests such as ultrasound or MRI, and specialized studies like defecography, may be used in selected cases to define the anatomy and function.

Treatment ranges from conservative measures to surgery. First-line options often include pelvic floor exercises (Kegels), weight management, treatment of constipation, and the use of a vaginal pessary to support the organs. When symptoms persist or anatomy is unfavorable, surgical repair may be recommended. Procedures vary by prolapse type and may involve vaginal repair, abdominal approaches, or repair with mesh in some settings. The goal is to restore support and relieve symptoms while preserving function.

Prolapse is typically a chronic condition that can be managed effectively, but recurrence after treatment is possible. Regular follow-up and lifestyle modifications help maintain results.