Prolapse is a common condition in medicine which occurs when the structures designed to keep organs in place weaken or stretch, causing them to literally “fall out of place”. The term can be used to describe misalignment of the valves of the heart (mitral valve prolapse), protrusion of the rectum (rectal prolapse), or even spinal disc herniation (lumbar disk prolapse).
Pelvic organ prolapse is a medical condition that arises when the normal support of the vagina is lost, resulting in the descent of one or more pelvic structures (bladder, urethra, cervix or vagina). The cause is multi-factorial, though primarily due to a loss of the support maintained by a complex interaction among the pelvic musculature, the vagina and the connective tissue.
Mitral valve prolapse
Mitral valve prolapse can be defined as abnormal bulging of the mitral valve leaflets into the left atrium during ventricular systole. The overall prognosis of patients with this condition is excellent, albeit a small subset can develop complications such as serious mitral regurgitation, arrhythmia, endocarditis, congestive heart failure and cerebrovascular ischemic events.
Myxomatous degeneration with genetic background is the most common cause of mitral prolapse. Echocardiography represents the method of choice for diagnosing mitral valve prolapse, and clinical and echocardiographic features can predict which patients with prolapse are at highest risk for the development of complications.
Although symptoms associated with this type of prolapse are often alleviated with beta-adrenergic blocking agents, there is no medication to correct or prevent progression of valve prolapse. Therefore surgical mitral valve repair using a variety of techniques is the treatment of choice for symptomatic prolapse.
Rectal prolapse (or procidentia) can be described as full-thickness protrusion of all layers of rectum through the anal canal into the external environment. It is most commonly found in young children and elderly people, and can be classified according to the severity as a complete rectal prolapse, a mucosal prolapse or an internal (often termed occult) rectal prolapse.
The precipitating factors in the development of this condition are not completely understood, but they include poor bowel habits, sliding herniation of a deep pouch of Douglas, relaxation of the rectal suspensory ligaments and rectal wall intussusception.
Patients with rectal prolapse frequently complain of bleeding, mucous drainage, incontinence, and sometimes even pain. The purpose of treatment for rectal prolapse is correction of the prolapsed rectum and prevention of the postoperative defecation dysfunction, most often with a surgical approach (which is contraindicated only in cases of severe comorbidities).
Lumbar disk prolapse
Lumbar disc prolapse (also known as slipped disc) accounts for less than 5% of all low back problems, but represents the most common cause of nerve root pain or sciatica. Pressure on one or several nerves that contribute to the sciatic nerve can result in lower back pain, as well as tingling, numbness, a “pins and needles” feeling and muscle weakness in the lower body.
Disc herniation occurs when the annulus fibrous breaks open or cracks, allowing the nucleus pulposus to escape. The intervertebral discs between relatively flexible lumbar vertebrae are particularly vulnerable to prolapse, as this region of the spine bears much of the body’s weight and supports a fairly wide range of motion.
In most instances, prolapsed disc symptoms can be managed through conservative or non-surgical treatments (i.e. pain medications, physical therapy, exercise or rest). Surgery is pursued in order to provide more rapid relief of pain and disability in the minority of patients whose recovery is unacceptably slow.