The "falling down" of any organ, usually
applied to the uterus (womb) and the rectum.
Prolapse of the uterus is relatively common,
particularly in elderly women. It is associated with the progressive weakness of
muscle and of other
supportive structures in the
pelvic area in later life. Often this is
caused by injury to or overstretching of the
pelvic floor in childbirth.
Injury to the perineum (the area of tissue
between the anus and the vulva) and to the vagina may contribute to the prolapse.
Prolapse of the
first degree implies the presence of the cervix (neck of the womb) at the vaginal opening. In
second-degree prolapse the cervix
protrudes through the vaginal opening; in
third-degree prolapse the entire uterus protrudes
through the vaginal opening. In some cases there are no symptoms apart from the mechanical discomfort of the movement of the uterus; but there may be some feeling of "bearing down" or
heaviness in the lower part of the abdomen and back.
Surgery is the ideal treatment in many cases. The
laxness in the ligaments and muscles is taken up and the uterus is returned to its
proper position. In women past childbearing age, them more radical operation of
removal of the uterus (
hysterectomy) may be preferred.
Another form of treatment in elderly women or in those who are poor operative risks is the insertion in the
vagina of a rubber ring to take up the slack in the
vagina and to support the neck of the womb.
In
prolapse of the rectum, the
rectal wall turns inside out and may protrude
through the anal opening; this is
complete prolapse. In
partial prolapse, only the mucous membrane protrudes. The latter is much more common, especially in old age, and the
protrusion is rarely more than 1 inch long.
Complete rectal prolapse is approximately five times as common in women as in men and is associated with repeated
pregnancies and consequent weakening of the pelvic floor. And condition, such as
chronic constipation, that leads to straining at stool may lead to prolapse, but the most common
cause is hemorrhoids ("piles"). Again, surgical treatment is
necessary if the prolapse is not to recur.
Attention must be given also to the predisposing causes.