Prolapse: assessment and therapy in Basel

Prolapse results from weakness of the pelvic floor, connective tissue and supporting ligaments. Vaginal births, oestrogen deficiency during and after menopause, chronic strain (coughing, constipation, heavy lifting) and congenital connective tissue weakness are the most common factors.

Risk factors

• –After vaginal births – especially multiple births or a large baby
• –During and after menopause (oestrogen deficiency)
• –Chronic cough, chronic constipation
• –Heavy lifting, physically demanding occupations
• –Overweight
• –Congenital connective tissue weakness
• –Increasing age

Frequency

Roughly one in two women develops some form of prolapse over the course of life; however, not all have relevant symptoms.

Typical symptoms

• –Pressure or sensation of a foreign body in the vagina
• –Visible or palpable bulge in the vagina
• –Pulling sensation in the lower abdomen, back pain – especially in the evening
• –Bladder symptoms: urgency, incomplete emptying, stress incontinence
• –Difficulty with bowel movements, sensation of incomplete emptying
• –Pain or discomfort during intercourse
• –Discomfort during exercise or lifting

Common incidental findings

• –Recurrent urinary tract infections
• –Dryness and irritation of the vagina (especially postmenopausal)

When is it detected?

Many women only notice the prolapse when symptoms worsen in the evening or they feel a bulge. Early assessment pays off – conservative measures work better the earlier they are started.

Assessment involves a careful history and a gynaecological examination with staging of the prolapse according to POP-Q. It is supplemented by ultrasound (including post-void residual measurement) and, if incontinence is present, a bladder diary. Complex findings are planned together with a specialised uro-gynaecological clinic.

Examinations

• –History: symptoms, everyday life, births, menopause, prior conditions
• –Gynaecological examination with POP-Q staging
• –Ultrasound of pelvic organs and bladder, post-void residual measurement
• –Bladder diary for incontinence
• –If needed: referral for urodynamic testing

What do the findings mean?

Watchful waiting

First choice for symptomatic prolapse is conservative measures: guided pelvic floor training with a specialised physiotherapist, weight optimisation, treatment of chronic cough and constipation, and back-friendly lifting technique. As support, our practice offers the EMP Chair Pro – a treatment chair that uses high-intensity electromagnetic impulses (HI-EMP) to contract the entire pelvic floor musculature involuntarily. You stay fully clothed, a session lasts around 28 minutes, is painless and needs no downtime. It strengthens and tightens the pelvic floor and therefore mainly relieves accompanying incontinence and a mild sense of heaviness; it does not anatomically correct a pronounced prolapse.

Medication

A pessary (ring, cube, shelf) supports the pelvic organs and urethra from within – it is very effective, has few side effects, and in many cases is a durable option, especially when surgery is not (yet) desired. During and after menopause, local oestrogen significantly improves the mucosa, sensitivity and susceptibility to infection, and increases tolerance of pessaries. Laser treatment does not correct the prolapse itself.

Surgery

For pronounced, symptomatic prolapse with insufficient response to conservative therapy, surgical procedures are considered – vaginal, laparoscopic, or as sacrocolpopexy. These procedures are performed at a specialised uro-gynaecological clinic; we support the indication process, preparation and follow-up care at the practice.

• –Regular pelvic floor training – especially after childbirth and during menopause
• –Keep weight within a healthy range
• –Treat chronic cough and constipation consistently
• –Use correct technique for heavy lifting, actively engage the pelvic floor
• –Seek assessment early at first symptoms – don't wait

• Pelvic floor training with the EMP Chair Pro→

  Strengthening and tightening the pelvic floor – fully clothed, painless.

• Intimate health→

  Pelvic floor training, pessary advice and laser therapy.

• Incontinence→
• Menopause→
• Vaginal dryness→
• Gynaecological ultrasound→
• Lichen sclerosus→

• ↗SGGG – Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe
• ↗AWMF S2e-Leitlinie – Descensus genitalis der Frau
• ↗NICE Guideline NG123 – Urinary incontinence and pelvic organ prolapse in women
• ↗International Urogynecological Association (IUGA)