prolaps

Prolapse, in medical terms, refers to the descent or slipping of an organ from its normal position. It most often involves pelvic organs or the rectum, but the term is also used for certain heart valve abnormalities such as mitral valve prolapse. Prolapse results from weakening of supporting tissues, often due to aging, childbirth, obesity, chronic straining, or connective tissue disorders.

Pelvic organ prolapse includes uterine prolapse, vaginal vault prolapse after hysterectomy, anterior vaginal wall prolapse (cystocele), and posterior vaginal wall prolapse (rectocele); enterocele is herniation of small bowel into the vaginal canal due to loss of support. Rectal prolapse is the full-thickness protrusion of the rectal wall through the anus. Bladder prolapse is commonly described as cystocele or urethrocele.

Causes and risk factors include multiple childbirths, advanced age, obesity, chronic constipation or diarrhea, heavy lifting, pelvic surgery, and connective tissue disorders.

Symptoms vary by type but may include a feeling of bulging or fullness in the vagina or rectum, pelvic pressure, urinary symptoms (incontinence or retention), fecal incontinence, constipation, or pain. Some prolapses are asymptomatic and discovered on examination or imaging. Diagnosis involves a pelvic exam and may use imaging tests such as defecography, MRI, or urodynamic studies; heart-related prolapse such as mitral valve prolapse is evaluated with an echocardiogram.

Treatment ranges from conservative to surgical. Conservative options include pelvic floor physical therapy, lifestyle modifications, weight management, and the use of a pessary to support the prolapsed organ. Medications may address constipation or incontinence. Surgical repair aims to restore support and may involve vaginal, abdominal, or combined approaches; uterus-sparing options exist in some uterine prolapse cases.

Prognosis depends on type and severity; recurrence is possible. Prevention focuses on maintaining pelvic floor strength through exercises, managing constipation, avoiding heavy lifting, and treating obesity.