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.
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.