Uterine or vaginal prolapse
Pelvic organ prolapse (PoP) refers to descent of pelvic organs (uterus, cervix or vaginal walls) down to or beyond the vaginal opening. It is a common condition and affects many women globally. A prolapse can significantly affect a woman’s quality of life including sexual function. With aging population, increasing awareness and willingness in women to report, the prevalence of PoP is expected to increase.
The common symptom of PoP is the “feeling of a bulge” or something coming out of the vagina. Women can also complain of backache, sexual dysfunction, difficulty in passing urine and/or in opening bowels. Some women with prolapse have to put pressure on their perineum to aid bowel opening.
Treatment options include conservative management or surgery. Conservative management includes Pelvic floor exercises, local (vaginal) estrogen cream and the use of various types of vaginal pessaries. Vaginal pessaries are various types of silicon devices (commonly rings) which are placed inside the vagina to treat prolapse.
Surgery for pelvic organ prolapse can be done vaginally, laparoscopically or with a combination of both. The route of surgery is individualised to cater to woman’s needs and type of prolapse.
Women with prolapse don’t always require a hysterectomy.
Urinary urgency and inadvertent loss of urine is common in women. It is often under reported and can be quite distressing.
Urinary incontinence can be stress, urge (overactive bladder) and a mixture of both (mixed incontinence). It can be difficult to make an accurate diagnosis clinically and to make a correct diagnosis urodynamic testing (see below) is often performed.
Urodynamic assessment is advanced testing of urinary bladder and its function. It provides more information regarding the cause of urinary incontinence and helps in guiding the treatment.
Treatment options for urinary incontinence include conservative management or surgery. Conservative management includes Pelvic floor exercises, local (vaginal) estrogen therapy and the use of various types of vaginal pessaries.
Surgery for stress urinary incontinence can be done vaginally (e.g. retropubic tape/sling) or laparoscopically (Burch colposuspension). Retropubic tape/sling is also called mid-urethral sling. It is a mesh device which is placed vaginally. Its alternative is laparoscopic Burch colposuspension which doesn’t involve the use of mesh.