Vaginal prolapse

Definition

What is vaginal prolapse?

The network of muscles, ligaments, and skin in and around a woman’s vagina acts as a complex support structure that holds pelvic organs, and tissues in place. This support network includes the skin and muscles of the vaginal walls (a network of tissues called the fascia). Various parts of this support system may eventually weaken or break, causing a common condition called vaginal prolapse.

Vaginal prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall out of their normal positions. Without medical treatment or surgery, these structures may eventually prolapse farther and farther into the vagina or even through the vaginal opening if their supports weaken enough.

How common is vaginal prolapse?

Vaginal prolapse is common. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of vaginal prolapse?

The symptoms most commonly associated with a vaginal prolapse depend on the type of vaginal prolapse present. The most common symptom of all types of vaginal prolapse is the sensation that tissues or structures in the vagina are out of place. Some women describe the feeling as “something coming down’ or as a dragging sensation. This may involve a protrusion or pressure in the area of the sensation. Generally, the more advanced the prolapse, the more severe the symptoms.

• The following are general symptoms that may be seen with of all types of vaginal prolapse:
• Pressure in the vagina or pelvis
• Painful intercourse (dyspareunia)
• A mass at the opening of the vagina
• A decrease in pain or pressure when the woman lies down
• Recurrent urinary tract infections

The following are symptoms that are specific to certain types of vaginal prolapse:

• Difficulty emptying bowel: This may be indicative of an enterocele, vaginal vault prolapse, or rectocele. A woman with difficulty emptying her bowel may find that she needs to place her fingers on the back wall of the vagina to help evacuate her bowel completely. This is referred to as splinting.
• Difficulty emptying bladder: This may be secondary to a cystocele, urethrocele, enterocele, vaginal vault prolapse, or prolapsed uterus.
• Constipation: This is the most common symptom of a rectocele.
• Urinary stress incontinence: This is a common symptom often seen in combination with a cystocele.
• Pain that increases during long periods of standing: This may be indicative of an enterocele, vaginal vault prolapse, or prolapsed uterus.
• Protrusion of tissue at the back wall of the vagina: This is a common symptom of a rectocele.
• Protrusion of tissue at the front wall of the vagina: This is a common symptom of a cystocele or urethrocele.
• Enlarged, wide, and gaping vaginal opening: This is a physical finding frequently seen in combination with a vaginal vault prolapse.

Some women who develop a vaginal prolapse do not experience symptoms.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes vaginal prolapse?

• Childbirth (especially large babies): Childbirth is damaging to the tissues, muscles, and ligaments in and around the vagina. Long, difficult labors and large babies are especially stressful to these structures. Childbirth is the risk factor most commonly associated with cystoceles, in which the bladder prolapses into the vagina. A cystocele is sometimes accompanied by a urethrocele, in which the urethra becomes displaced and prolapses. A cystocele and urethrocele together are called a cystourethrocele.
• Menopause: Estrogen is the hormone that helps to keep the muscles and tissues of the pelvic support structures strong. After menopause, the estrogen level declines; and the support structures may weaken.
• Hysterectomy: The uterus is an important part of the support structure at the top of the vagina. A hysterectomy involves removing the uterus. Without the uterus, the top of the vagina may gradually fall toward the vaginal opening. This condition is called a vaginal vault prolapse. As the top of the vagina falls, added stress is placed on other ligaments. Hysterectomy is also commonly associated with an enterocele, in which the small intestine herniates downward near the top of the vagina.

Risk factors

What increases my risk for vaginal prolapse?

There are many risk factors for vaginal prolapse, such as:

• Advanced age
• Obesity
• Dysfunction of the nerves and tissues
• Abnormalities of the connective tissue
• Strenuous physical activity
• Prior pelvic surgery

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is vaginal prolapse diagnosed?

Women without symptoms are often diagnosed with the problem during routine gynecological examinations. Symptomatic women are also usually diagnosed by their gynecologist. Physicians who specialize in gynecology can typically diagnose it with a thorough medical history and physical exam. Laboratory testing or imaging studies are rarely needed.

These physical examinations include a bladder function test and a pelvic floor strength test.

• Pelvic floor strength test: During the pelvic examination, the doctor tests the strength of the pelvic floor, the sphincter muscles, and muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. Irregularities in this test can help diagnose vaginal prolapse and determine if kegel exercises would be helpful to the patient.
• Bladder function test: Otherwise known as urodynamics, bladder function tests determine the ability of the bladder to store and eliminate urine. This is measured two ways. Uroflowmetry measures the volume and force of the urine stream. Cystometrogram is a procedure which fills the bladder with water via catheter. Measurements of volume are noted when the patient indicates urgency of urination.

How is vaginal prolapse treated?

As with most medical conditions, conservative approaches are employed first, primarily pelvic exercises designed to strengthen the muscles in the entire region. Women whose age or physical condition may prohibit exercise may be fitted with a pessary, a vinyl ring inserted in the vagina to hold the prolapse in place.

Surgical treatment options

If conservative measures fail, your physician may recommend surgery to help fix vaginal prolapse. When you meet with your surgery specialist, you may discuss your age and general health, desire for future pregnancies, wish to preserve vaginal function, the degree of prolapse and anatomic conditions that affect decisions as to which surgical procedure to pursue. For instance, a hysterectomy (removal of the uterus) may be required when significant prolapse is present.

There are two primary approaches depending on the condition. Many surgeries are conducted through the vagina, an approach that leaves no scars, while laparoscopy is an increasingly sought after method of repairing prolapse. These surgical procedures are conducted through narrow tubes inserted through incisions less than an inch long. These procedures have been shown to reduce scarring, blood loss, and hospital stays, and speed recovery times.

A surgical procedure called anterior colporrhaphy tightens the front walls of the vagina, while posterior colporrhaphy tightens the back walls. Laparoscopic procedures are employed to relieve stress incontinence, repair hernias at the top of the vagina, and to create support for vagina’s that have become weakened by a hysterectomy. In instances in which supporting tissues have been weakened, additional natural tissue or artificial materials (mesh) may be placed to support the repair.

Hospitalization is brief, usually a day, sometimes two and seldom more than four. Patients are released with prescriptions for pain killers and antibiotics to prevent infection.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage vaginal prolapse?

The following lifestyles and home remedies might help reduce your risk of vaginal prolapse:

• Perform Kegel exercises on a regular basis. These exercises can strengthen your pelvic floor muscles — especially important after you have a baby.
• Treat and prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grain cereals.
• Avoid heavy lifting and lift correctly. When lifting, use your legs instead of your waist or back.
• Control coughing. Get treatment for a chronic cough or bronchitis, and don’t smoke.
• Avoid weight gain. Talk with your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.