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Wednesday, February 11, 2015

What is Prolapse?

It is quite interesting to sit back and observe the chaos what at present is raging in the minds of those who choose to keep them busy with the females who have pelvic floor damage. The simple question asked will probably have different answers. What the author is going to do is to keep it simple and a little bit stupid -and stay with only the defining of what we are dealing with.

"Prolapse" is seen as a collapse of the vaginal wall when intra abdominal pressure increase - this will present itself as a ball that comes down the cavity and in extreme circumstances protrude through the vaginal opening. This is here that the confusion starts: it is seen by most authors as a "prolapse of pelvic organs", hence the name and classifications based on the supposed organ that will be in the ball. The words POP (Pelvic Organ Prolapse), cystocoele ("sac of the bladder"), rectocoele ("sac of the rectum") -this is sometimes even sub classified as high and low- and enterocoele (" sac of the intestines") is used by most. No reference is made to the underlying reason why the vaginal wall is collapsing- the structural support of the vaginal cavity, which is in essence a tunnel that ends blindly into the abdominal cavity and is subjected to varying degrees of pressures, has weak areas on specific spots and it is through these areas that herniation of abdominal contents protrude, pushing the vaginal skin ahead of it. A comparison with abdominal wall herniations, e.g. inguinal hernias, can be made.

 It is at this simple starting point that difference of opinions arise on how to treat this " prolapsed" wall:
If seen as a "organ prolapse" the avenue to treat that will be followed is to push, or pull, this out of the cavity - the so called "colphorrhaphies" is done whereby the protruding wall is folded onto itself with removal of extra skin/tissues, or the vaginal wall is strapped to the bone skeleton (sacro colpopexy or rectopexy): no attention is given to the underlying defects that lead to the protrusion or herniation -in a sense is this a symptomatic treatment at best.
If seen as a defect in the wall that leads to the protrusion, the treatment will be focused on finding these spots of weakness and the subsequent surgery will focus on strengthening these. The surgical approach will thus aim at diagnosing , and laying bare, the defects -the better this is done, the better the chances of correcting it can be done. The definitions of these defects will thus focus on an anatomical definition which will define the area where the weakness is and not on what the supposed contents of the hernial sac is -this will thus focus on treating the cause and origin of the protruding wall, rather that attacking the sac directly with an obvious more enduring result.

In this blog the last avenue of thinking is being explored and developed.


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