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Cystocele and Rectocele

What is a vaginal prolapse?

A prolapse is a bulge in the vagina caused by a weakness in its supporting structures. It may involve the womb alone, the vagina alone, or both the womb and the vagina. There are three common types of vaginal prolapse: cystocele, rectocele and enterocele. The management options and possible surgery performed will depend on the type of prolapse.

  • A cystocele is a bulge in the front wall of the vagina which allows the bladder to move downwards. It may cause urine to leak, called urinary incontinence.
  • A rectocele is a bulge in the back wall of the vagina which allows the back passage (rectum) to move downwards.
  • An enterocele is a less common type of prolapse in which the small bowel bulges down through the vagina.

The prolapsed can be graded in to mild/moderate or severe with the treatment options given varying on your health, your wishes and any other problems that may be encountered.

Alternatives to surgery

  • Pelvic floor exercises - These may help to strengthen your pelvic floor muscles if your prolapse is minor.
  • Vaginal pessary - This is a plastic ring put inside your vagina to prevent any loose vaginal skin from coming down. It can be an effective and comfortable alternative to surgery, but does not work for everyone. With regular checking it may work for many years.

 All of these alternative treatments may be improved by hormone replacement therapy (HRT) or by using hormone creams, called oestrogens. These help by increasing the blood supply to your pelvic organs.

What if you do nothing?

Without treatment your prolapse will usually become steadily worse. Although a prolapse can be very uncomfortable, it rarely causes a serious risk to your health. If your vaginal skin lies outside your body it will be damaged as it becomes sore, cracked and dry. If you have a third degree prolapse it can sometimes put pressure on your ureters and kidneys, causing serious problems with passing urine. If the prolapse can be repaired, there is usually little sense in putting up with the symptoms.

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