Pelvic Organ Prolapse in Gurugram

The muscles and ligaments that hold the pelvic organs in place have stretched or given way, so one or more of them presses into the wall of the vagina. It is a mechanical problem with the supports rather than a disease of the organ itself, which is why the treatments are about support rather than about removing anything.

Very. If women are examined, somewhere between four and five in ten have some degree of prolapse. Only around three in a hundred report a bulge that troubles them. Those two figures together explain both why it is so common and why most of it never needs treating.

Named by which compartment has dropped. A cystocele is the bladder pressing into the front wall. A rectocele is the rectum pressing into the back wall. Uterine prolapse is the uterus descending. Vault prolapse is the top of the vagina descending after a hysterectomy. An enterocele is small bowel pushing into the upper back wall. More than one often occurs together.

Because the operation follows the compartment, not the word. An anterior repair does nothing for a rectocele, and removing the uterus does nothing for a cystocele. Asking which compartments are involved and to what degree is the single most useful question you can put at your appointment.

A system that measures how far specific points on the vaginal walls sit relative to the hymen, producing a stage from 0 to 4. Stage 0 is no prolapse and stage 4 is complete eversion. It is a careful anatomical description, useful for planning surgery and for comparing over time.

Not in terms of how you feel. The stage measures anatomy, not symptoms, and the two correlate poorly. A stage 2 prolapse that is ruining a woman's life deserves treatment; a stage 2 prolapse she has never noticed does not. Being offered surgery because of a number rather than because of something you described is a reason to pause and ask.

Not necessarily, and this is widely misunderstood. Prolapse can progress, can stay the same for years, and can improve, particularly with weight loss and proper pelvic floor work. It is often assumed to be a one-way road, which is why women agree to operations they do not yet need.

A bulge or a feeling of something coming down, usually worse by the end of the day and better lying down; a dragging heaviness low in the pelvis or back; urinary symptoms including incomplete emptying and sometimes having to push the bulge back before urine will come; difficulty emptying the bowels; discomfort during sex; and sometimes soreness or spotting where the tissue has dried.

Pressing on the back wall of the vagina or around the perineum to get the bowels to empty. It points specifically at the posterior compartment, it is one of the most useful things you can tell a doctor, and almost nobody mentions it unless asked directly. An operation on the front wall will do nothing for it.

It can. A bladder that does not empty properly is a bladder that keeps getting infected, so recurrent urinary infections are sometimes the first clue that a prolapse is present. Treating the infection alone will not solve it if incomplete emptying is the reason.

Vaginal childbirth is the single largest factor, with the risk rising with the number of deliveries, a large baby, a long second stage and forceps. Age and the fall in oestrogen after menopause, extra weight, chronic constipation or coughing, repetitive heavy lifting, naturally elastic connective tissue and previous pelvic surgery all contribute. None of it is something you did wrong.

Yes, though it is much less common. Naturally more elastic connective tissue, chronic straining, heavy lifting and a strong family tendency can all produce prolapse in a woman who has never delivered. It is also seen after previous pelvic surgery.

For symptomatic stage 1 and stage 2 prolapse, they are the recommended first treatment. The specification matters: guidance says a supervised programme for at least sixteen weeks. Supervised means taught and checked by someone who confirms you are contracting the right muscle, and a large proportion of women who think they are doing pelvic floor exercises are squeezing the wrong muscles entirely.

Give it the full sixteen weeks before judging. Improvement is gradual rather than sudden, and stopping at six weeks because nothing has changed is the commonest reason the treatment is written off. Once the technique is learnt, continuing it long term is what maintains the benefit.

A device that sits inside the vagina and holds the prolapse up. It comes in several shapes and sizes, it is fitted rather than prescribed, and it can be used for years. Guidance recommends offering one either alone or alongside pelvic floor training. It is the single most under-offered treatment for prolapse in Indian practice.

It is a treatment in its own right, not a holding measure. Many women use one indefinitely and never have surgery. It suits women who want to avoid an operation, who are not fit for one, who have not completed their family, or who simply want to see how much of their discomfort is due to the prolapse before deciding anything.

It should not be. If it is, the size or shape is wrong and it should be refitted rather than abandoned. Several fittings are sometimes needed to find the right one, and giving up after a single attempt is common and unnecessary. Thin tissues make discomfort much more likely, which is why topical oestrogen is usually started first.

It should be removed and checked at least once every six months to prevent complications, and more often for women at higher risk. That follow-up should be agreed at the time it is fitted rather than left open-ended.

It depends on the type. Some can be left in and some are removed beforehand, and some women learn to take theirs out and reinsert it themselves. It is a reasonable question to ask when it is being fitted, and it should be discussed rather than left for you to work out.

It is recommended where there are signs that the tissues have thinned, which is common after the menopause. It makes a pessary far more comfortable and much less likely to cause a sore spot, it settles ulceration where the prolapse has been sitting outside, and it improves the condition of the tissues before any surgery. It acts locally, which is why it suits many women who do not want hormones by mouth.

Not routinely. Guidance is explicit that imaging should not routinely be done to document a prolapse that can already be seen on examination. The examination is the test. Imaging is reserved for specific questions that the examination cannot answer.

No. If you want to keep your uterus, the recognised options are a sacrospinous hysteropexy using sutures, a Manchester repair, or a sacro-hysteropexy with mesh done abdominally or laparoscopically. The uterus is not what failed; its supports are. Keeping it is a legitimate choice rather than an indulgence, and it should be offered.

Not by itself. A hysterectomy does not repair the supports, and the top of the vagina can descend afterwards, which is what vault prolapse is. That is one of the reasons an operation that removes the uterus is not automatically the more definitive choice, and it is worth saying out loud when the options are being discussed.

It depends entirely on the operation, and this is the most confused subject in the whole area. Transvaginal mesh for front and back wall repairs is restricted to research settings, and those repairs are done with your own tissue. Mesh used abdominally or laparoscopically to suspend the top of the vagina or the uterus is a different operation with different evidence, and it remains an offered option.

You should be informed rather than frightened. If mesh is used, guidance requires that you are told what type it is and whether it is permanent, that the procedure goes on a registry, and that you are given written information naming the implant, the manufacturer, the date and the surgeon. If none of that is offered, ask for it. Refusing an appropriate abdominal operation out of fear of a different, restricted vaginal procedure is a real and avoidable loss.

Guidance sets it out: every option including doing nothing and continuing non-surgical treatment; the benefits and risks of each operation including effects on urinary, bowel and sexual function; the risk of the prolapse coming back; the uncertainty about long-term effects, particularly with mesh; the differences in anaesthetic, hospital stay, incisions and recovery; and the fact that the plan may change once the surgeon can assess things under anaesthetic.

It can, and you should be told so before you consent rather than discovering it later. The tissue that failed the first time is the same tissue being repaired, so recurrence is a recognised outcome rather than a sign that something went wrong. Continuing pelvic floor work, managing weight and avoiding chronic straining all reduce the chance.

It is possible, and guidance specifically requires that women having surgery for anterior or apical prolapse without existing incontinence are warned about it. Repairing a prolapse can unmask leaking that the prolapse was effectively masking, and further treatment may then be needed. It is a reason to raise urinary symptoms clearly beforehand.

For most women, yes, and often more comfortably than before. Effects on sexual function are part of the conversation guidance requires before consent, so it is a legitimate thing to ask about directly rather than hope for. Avoiding sex out of embarrassment about a bulge is one of the things treatment most reliably fixes.

After, wherever possible. A future pregnancy and delivery can undo a repair, so if you may want more children say so early. It rules out some operations entirely and it is a strong argument for a pessary in the meantime, which is a perfectly reasonable way to manage prolapse for years.

Any previous notes or operation records, particularly if you have had a hysterectomy or a previous repair. A note of what the symptoms stop you doing, and of anything already tried and for how long. And the bowel and urinary details, including whether you have to press to empty your bowels, because those are the things most often left unsaid.