Prolapse is when one or more of your pelvic organs shift out of place. It is a common condition affecting 6% of women under 30, 30% of women age 51-59 years and 50% of women over 80.
Sometimes only a little movement inside can cause a lot of bothersome symptoms, yet other women can see and feel a large bulge or protrusion without any bother. It is a complicated condition and you will need advice from your GP or a specialist physiotherapist to understand fully what is going on for you.
The primary cause of prolapse is a change in the support structures of the organs. This includes their ligament and fascial attachments as well as the pelvic floor muscles supporting them from below. There is no single cause of the problem, rather layers of events occurring that change the support system. Some are in your control but many are not. Childbirth, BMI, age, family history, constipation, and your collagen type all have an influence.
Pregnancy and Childbirth
You are more likely to develop a prolapse if you’ve had children. Both pregnancy and the type of delivery affect your likelihood.
- Pregnancy hormones cause the pelvic floor muscles and other soft tissues to relax to accommodate the baby and prepare for childbirth.
- Carrying the weight of a babycan cause the pelvic floor muscles to stretch and loosen.
- A vaginal delivery, especially a traumatic one, can disrupt the support structures of the organs. This includes their ligament and fascial attachments as well as the pelvic floor muscles supporting them from below.
- Giving birth vaginally can cause scar tissue and nerve damage, which can take time to heal.
Other Causes of Pelvic Organ Prolapses
Younger women who haven’t had children can also suffer a pelvic organ prolapse due to other risk factors:
- Chronic lung disease such as bronchitis or asthma, or smoking, all of which can cause a persistent and heavy cough which puts pressure on the pelvic floor muscles and other support tissues.
- Connective tissue or collagen disorders such as lupus or rheumatoid arthritis.
- Having had previous surgery for abdominal hernias.
- Being overweight or obese from a very young age.
- Having persistent and regular constipation, meaning that you have always had to strain to pass a bowel movement.
- Having a job that requires lifting heavy loads.
- Having a hysterectomy (a complete removal of the womb) means that the top support for the vagina is no longer present and can cause a vaginal vault prolapse.
What Are the Symptoms of a Prolapse at a Younger Age?
The symptoms of a pelvic organ prolapse do not differ depending on age. However, depending on your overall health and the stage of your prolapse, you may experience some or all of the following symptoms:
- Difficulty or pain when having sex
- Loss of sensation or ‘tightness’ when having sex
- Difficulty urinating
- A frequent urge to urinate
- An urgent urge to urinate
- Frequent bladder infections such as cystitis
- Feeling unsatisfied that you’ve emptied your bladder after going to the toilet
- Urinary incontinence – the inability to hold in urine
- Urinary stress incontinence – the inability to hold in urine when you cough, laugh or run etc.
- Constipation
- Pain in the lower back or pelvic area
- A feeling of pressure inside the vagina
- A feeling that there is something inside the vagina
- A dragging feeling inside the vagina
- Tissue protruding to the outside of the vagina
What Can Be Done to Prevent Prolapse in Younger People?
As with any medical complaint, prevention is better than cure. There are many lifestyle habits you can take to help prevent a weakening of the pelvic floor muscles and subsequent prolapse, regardless of whether you’ve had children or not:
- Maintain a healthy weight of less than 30 BMI.
- Eat a healthy diet full of fibre to avoid constipation.
- Stay well hydrated to avoid constipation.
- Use a toilet stool to go to the toilet in a more natural ‘squat’ position and avoid straining.
- Seek medical help or take steps to avoid a chronic cough (such as quitting or not taking up smoking).
- Learning to lift properly or avoiding lifting altogether.
- Check your technique for high impact exercise, such as running, and balance out with pelvic floor friendly lower impact exercise.
- do Kegel / or pelvic floor exercises daily.
These preventative steps, due to their strengthening of the pelvic floor, will reduce your risk of suffering from a severe prolapse in the future.
What Treatment Options are Available for Prolapses at a Young Age?
If you have a pelvic organ prolapse, and you’re a younger woman, your doctor will usually avoid surgery and only perform it if it is absolutely necessary. This is because falling pregnant after a vaginal prolapse repair will likely mean that the operation will be undone and will need to be carried out again. Instead, your doctor will usually ask you to make the preventative lifestyle changes mentioned above. These are often enough to treat mild and moderate prolapses.
They may suggest fitting a vaginal pessary to support your prolapse. It’s a small device, usually made from silicone, that is placed inside the vagina to help support the vaginal wall and prevent other pelvic organs collapsing further into it. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women. Your doctor can help you find the right one and help you change the pessary every four to six months. This is commonly the favoured treatment for those unable to undergo surgery due to other medical conditions or those wishing to have children in the future. Some vaginal pessaries need to be removed for sexual activity and you can learn to do this yourself.
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