What causes prolapse?
The causes of any prolapse or hernia are multifactorial. Simply, the supporting tissue is unable to cope with the strains being placed upon them. In the case of genital or vaginal prolapse these causes can be divided into two groups. Factors that cause increased abdominal pressure are at risk of causing the pelvic floor to fail or be damaged. These commonly include
- Chronic chest problems causing chronic coughing
- Constipation or straining to defecate
- Work or lifestyle that requires heavy lifting or abdominal straining.
- Pelvic masses ie uterine fibroids or ovarian masses are rare but can occur.
The second common cause is a pelvic floor that is weak or damaged and is unable to effectively resist normal increases in abdominal pressure. Common causes of pelvic floor weakness include
- Neuropathy: the nerves supplying the muscles are damaged. Common causes of neuropathy to the pelvic floor include age and childbirth.
- Tears or traumatized muscle or floors.
- Inherited weakness of pelvic floor collagen, fascia or muscle.
- Postmenopausal women are at increased risk and oestrogen deficiency may be a risk factor.
A final increasingly common cause of prolapse is as a result of the vaginal axis or orientation being altered. Examples of this include:
- After a colposuspension, where the front wall of the vagina is resupported, this may result in increased pressure of the back wall causing prolapse at these sites in 10-15% of women at a latter date.
- After a sacrospinous fixation. Here the vaginal axis is lengthened and moved posteriorly and on this occasion this may result in increased tendency for prolapse of the front wall (cystocele).
- A deficient perineum may cause an increased risk of prolapse as the support offered to the upper vagina and bladder by the perineum is lost. The commonest cause of perineal deficiency is vaginal childbirth and episiotomy repair.