Organ descent, or prolapse, a little-known and still taboo pathology

"Essentially female" pathology, impressive but without vital risk, genitourinary prolapse is better known under the name of "organ descent".

How to recognize the signs of an early prolapse, how to avoid it, how to remedy it: Europe 1 takes stock of this little-known and taboo pathology. 

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Better known under the name of "organ descent", genitourinary prolapse is an "essentially female" pathology, explains Yannick Rouach, surgeon-urologist, at the Private Hospital of Antony, in Hauts-de -Seine.

The risk of a woman having an operation for this disease is 11 to 19% during her lifetime, according to the Health Insurance website.

But what does this pathology consist of, how to recognize the signs?

In Sans Rendez-Vous, the urological surgeon takes stock of this still little-known and very impressive disorder.

Slippage of the pelvic organs

The prolapse corresponds in the patient to a sliding of the organs of the small pelvis downwards, that is to say the vagina.

Usually, the bladder, uterus, and rectum are supported by the pelvic floor, or perineum.

However, when the tissues or ligaments in this area become distended, these organs "can unhook and by gravity descend, and issue through the vagina", explains Yannick Rouach.

The term cystocele designates the prolapse of the bladder, the hysterocele that of the uterus and the rectocele, which is rarer and which can also affect men in specific cases, for the rectum.

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Before being exteriorized, in some cases, the pelvic organs press on the vaginal wall, creating discomfort in those affected.

To prevent the prolapse from reaching an advanced stage, it is important to pay attention to the sign to identify the pathology at a "beginning" stage:

- "We can realize this because we have difficulty urinating, a need to push to urinate or abnormal needs, urinary leaks due to urgencies for example", explains the urologist surgeon.

- "One can also feel a pelvic heaviness, in particular at the end of the day after having walked, that is to say a heaviness in the vagina".

If in doubt, do not hesitate to consult your doctor first, who will then refer the patient to a urologist.

Without panicking, recalls Yannick Roach.

"There is no emergency because there is no vital risk", he assures, while explaining that this pathology remains "impressive" and "morally complicated".

Especially when the prolapse is externalized, i.e. the pelvic organs come out.  

Several risk factors

Several factors can promote prolapse: pregnancies, in particular multiple pregnancies, the repetition of natural deliveries, a relaxation of the muscular or hormonal perineum, or repeated abdominal hypertension.

"Women who cough chronically, who are overweight, who make significant physical efforts, such as weightlifters for example," lists the urologist surgeon.

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"Sometimes this also concerns women affected by anorexic disorders, because this pathology relaxes the perineum: the tendons are looser and there is less maintenance of the organs."

Contrary to popular belief, no sexual practice can lead to a prolapse, "he adds.

How to cure it ?

Several hygienic and dietary advice can be used to treat an early prolapse.

“We can lose weight, facilitate transit, do physiotherapy to re-muscle the perineum in moderate settings,” explains Dr. Yannick Rouach.

Hormonal treatments, in the midst of debate in the medical community, also allow, according to him, to strengthen the vagina, "which is the key to many things".

"If we cannot do it in general, at least locally with eggs or creams," he continues.

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In too advanced cases and when the organ has already descended, the treatments cannot fight against gravity.

The patient will have to go through a surgical operation.

One of the techniques that can be used is promontofixation: an intervention that takes place by laparoscopic route, that is to say by abdominal route.

You access the inside of the abdomen through small incisions.

"Using two strips, we catch the bladder, the uterus, the vagina, the rectum and we hang them on ligaments a little solid so that it remains in place", schematizes Yannick Rouach.

"Like all mechanical surgeries, it works very well."

Another technique is to go through the vagina, and can go as far as fitting a synthetic reinforcement prosthesis to prevent the prolapse from recurring.