Pelvic prolapse
What is prolapse?
Prolapse may also be called uterine prolapse, genital prolapse, uterovaginal prolapse, pelvic relaxation, pelvic floor dysfunction, urogenital prolapse or vaginal wall prolapse.
Types of prolapse
Pelvic organ prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. The womb (uterus) is the only organ that actually falls into the vagina. When the bladder and bowel slip out of place, they push up against the walls of the vagina. While prolapse is not considered a life threatening condition it may cause a great deal of discomfort and distress.
There are a number of different types of prolapse that can occur in a woman's pelvic area and these are divided into three categories according to the part of the vagina they affect: front wall, back wall or top of the vagina. It is not uncommon to have more than one type of prolapse.
Prolapse of the anterior (front) vaginal wall
diagram of cystourethroceleCystocele (bladder prolapse)
When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall. It's common for both the bladder and the urethra (see below) to prolapse together. This is called a cystourethrocele and is the most common type of prolapse in women.
Urethrocele (prolapse of the urethra)
When the urethra (the tube that carries urine from the bladder) slips out of place, it also pushes against the front of the vaginal wall, but lower down, near the opening of the vagina. This usually happens together with a cystocele (see above).
diagram of enteroceleProlapse of the posterior (back) vaginal wall
Enterocele (prolapse of the small bowel)Part of the small intestine that lies just behind the uterus (in a space called the pouch of Douglas) may slip down between the rectum and the back wall of the vagina. This often occurs at the same time as a rectocele or uterine prolapse (see below).
Rectocele (prolapse of the rectum or large bowel)
This occurs when the end of the large bowel (rectum) loses support and bulges into the back wall of the vagina. It is different from a rectal prolapse (when the rectum falls out of the anus).
Uterine and vaginal vault prolapse (apical or top)Uterine prolapse
diagram of uterine prolapseUterine prolapse is when the womb drops down into the vagina. It is the second most common type of prolapse and is classified into three grades depending on how far the womb has fallen.
Grade 1: the uterus has dropped slightly. At this stage many women may not be aware they have a prolapse. It may not cause any symptoms and is usually diagnosed as a result of an examination for a separate health issue.
Grade 2: the uterus has dropped further into the vagina and the cervix (neck or tip of the womb) can be seen outside the vaginal opening.
Grade 3: most of the uterus has fallen through the vaginal opening. This is the most severe form of uterine prolapse and is also called procidentia.
Vaginal vault prolapse
diagram of vaginal vault prolapseThe vaginal vault is the top of the vagina. It can only fall in on itself after a woman's womb has been removed (hysterectomy). Vault prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.
Describing the severity of a prolapse
Most women, and their doctors, describe the severity of a prolapse simply as mild, moderate or severe. There is, however, a grading system that uses numbers to describe the extent of a prolapse. In the past, the grading system for uterine prolapse (1, 2, 3) was also used for other types of prolapse. This wasn't technically accurate, and a new, more precise classification system has recently been developed.
The new grading system uses a series of measurements and is fairly complicated, but generally categorises the severity of prolapse into stages I, II, III or IV. Stage I is mild prolapse. Stage IV is severe prolapse. Some doctors may still refer to prolapse using the older classification of 1, 2 and 3.
