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Prolapse – Information for GPs

Definition

Weakness of the vaginal walls with/without significant descent of the cervix. Presenting symptom usually a ‘lump down below’ may be associated with bladder or bowel symptoms.

  • Cystocele: anterior vaginal wall prolapse
  • Rectocele: posterior vaginal wall prolapse
  • Enterocele: prolapse of the vaginal vault (usually as a result of hysterectomy)
  • Uterine prolapse: graded 1 minimal descent to 4 procidentia

Red flag symptoms

  • Exclude cancerous cause for ‘lump’
  • New presentation of procidentia with poor urinary output – consider acute gynaecology admission

Management

  • History – including associated bladder and bowel symptoms
  • Examination – establish type of prolapse and any underlying atrophy. Note present of urethral caruncle (or prolapse) is pathognomonic of oestrogen deficiency. For more information please click here
  • Assess urinary symptoms – consider bladder diary and details of bladder drill
  • Treat underlying atrophy – vagifem 10mg/gynest cream daily for 2w, then twice weekly for 3m
  • Cystocele / Uterine Prolapse present – consider fitting a ring pessary
  • Pelvic Floor exercises
  • Women’s health physio – all women with prolapse should be referred first for Gynae physio prior to considering surgery, as outcomes are much better

Investigations prior to referral

  • Bladder diary
  • Gynae physiotherapy completed

Information to include in referral letter

  • Reason for referral
  • Examination findings
  • Treatment to date:
    - Gynae physiotherapy completed
    - Atrophy treated
    - Bladder drill/urinary symptoms addressed
  • Bladder diary completed and attached
  • Past medical/surgical history
  • Drug history
  • BMI (must be below 35)
  • Smoking cessation

Patient support

References

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