Prolapse is a health problem that is often taboo, with one in three women likely to be affected at some point in their lives, and one in ten women may need surgery. Commonly called “organ descent”, this problem occurs when one of the organs present in the pelvis (the bladder, rectum or uterus)[1] is no longer held by the muscles and ligaments constituting the pelvic floor.
The lack of communication around organ descent means that a lot of misinformation still circulates, hindering the ability of affected women to make informed decisions about their health. Recently, for example, a study published in the Journal of Obstetrics and gynaecology Canada highlighted the dangers of a practice called “vaginal sauna”, which involves sitting over a container of scalding water and herbs, and which has sometimes been touted as helping to alleviate the symptoms of prolapse.
However, this is a risky approach, which is completely not based on rigorous scientific data, and which can result in second-degree burns. In addition, certain information sites sometimes convey preconceived ideas, such as for example that prolapse exclusively concerns women after pregnancy.
What are the risk factors that actually predispose to prolapse? What treatment options are available today for people who suffer from it? Canal Détox returns to these questions in this new article in its “Women’s Health” series.
Prolapse affects many people
Often considered taboo, organ descent is often relegated in the collective imagination to an uncommon disorder, which only affects women after childbirth.
It is true that pregnancy is a risk factor and that the probability of developing prolapse increases if the patient has had several deliveries and/or has given birth vaginally, particularly with the use of forceps. However, women who have not had children may also be affected, as other factors may increase the likelihood of developing prolapse. Among other risk factors, age up to 50 years is significantly associated with an increase in prevalence.
After menopause, the prevalence remains stable but the severity of prolapse increases. Chronic constipation, obesity, certain congenital vaginal malformations, certain rare connective tissue diseases (such as Ehlers-Danlos syndromes) or even the practice of certain very intense and regular physical activities have also been implicated.
Finally, if rectal prolapse – when the rectum is no longer supported by the pelvic floor – still affects women more than men, the latter can also be affected. When this is the case, the prolapse occurs earlier than in women, before the age of 40. In general, rectal prolapse is less common in the adult population than other forms, with a prevalence of around 0.5% according to certain sources (even if data on the subject remains rare and detection difficult).
Develop new treatments
In the case of genital prolapse which affects women, the therapeutic options proposed will depend on the age of the patient and the severity of the symptoms. For a moderate case, it is possible to propose preventive measures (weight loss if necessary, adaptation of physical activity, etc.) aimed at controlling the evolution of symptoms, perineal rehabilitation measures, or the wearing of a pessary (a silicone intravaginal device).
Surgery is suggested if other measures are not sufficient and if the symptoms become disabling in daily life. Several techniques (abdominal surgery and vaginal surgery) are possible depending on the patient’s profile, but all have limitations.
The main problem is that currently, synthetic prostheses that were used to support organs in vaginal surgery – faster than abdominal surgery and not requiring general anesthesia – are no longer permitted.
Indeed, they sometimes cause severe complications, extreme pain, or even disability. In France, they are responsible for serious complications in 2.8% of cases in the short term after surgery. It is also very difficult to remove them once installed.
Research teams, particularly at Inserm, are therefore working to propose alternatives, for example prostheses made of biological material, which do not shear the organs and limit inflammatory reactions. However, these major works will still require time and funding to be completed.
In the meantime, the limited number of solutions for some women may lead them to turn to alternative therapies, sometimes presented as “miraculous”, even though they may carry risks.
Let us therefore recall once again that neither the “vaginal saunas” mentioned above, nor the consumption ofAloe veranor techniques such as acupressure or foot reflexology have been proven to prevent or treat prolapse. Their usefulness in supporting perineal rehabilitation is also not based on solid scientific foundations.
Prolapse constitutes a public health problem that doctors will have to face. Proposing a medicine centered on listening to patients in order to implement the right prevention measures at the right time and diagnose quickly, but also continuing research for the benefit of women, constitute priorities for the health system in the years to come .
Text written with the support of Diane Potart and Yoann Torres, researchers at the Biotis laboratory at Inserm in Bordeaux.
[1] We will speak of genital prolapse when the vagina exteriorizes through the vulva. We will speak of rectal prolapse when the rectum exteriorizes through the anus; men can also be affected.
