Vaginal Prolapse

Vaginal prolapse occurs when the tissues supporting the vagina weaken, causing the bladder, rectum, or uterus to protrude into the vaginal space. This can lead to symptoms like pelvic pressure, discomfort, or a noticeable bulge. Treatment options range from exercises to surgery, depending on the severity and impact on daily life, so consulting a healthcare provider is crucial for personalized care.

What is vaginal prolapse?

Vaginal prolapse is when the top of the vagina falls from its natural place in the body. The vagina, also called the birth canal, is a tunnel that connects the uterus to the vaginal opening. When the top of the vagina weakens, the organs they are supposed to support collapse into the vagina, creating the sensation of a lump or bulge.

The vagina is one of several organs located in the pelvic area of the body. These organs are held in place by muscles and other tissues. These muscles come together to form a support structure called the pelvic floor. Throughout life, this support structure can begin to weaken. This can happen for several reasons, but the result is the sagging of your limbs.

Prolapses can be small or large. Small prolapse is called incomplete prolapse. A larger prolapse occurs when the organ is significantly displaced. Complete prolapse can cause organs to protrude from the vaginal opening. This prolapse is very severe. Vaginal prolapse can cause painful symptoms. Mild to moderate vaginal prolapse may not require surgery. However, more severe cases may require surgical repair.

Different types of prolapse

The pelvis consists of the uterus, vagina, rectum, bladder and urethra. These organs are supported by the pelvic floor muscles, which look like an upside-down umbrella. The umbrella holds the pelvic organs up, but this inverted umbrella can begin to collapse over time or due to other factors such as natural childbirth.

Different types of prolapse have different names depending on where the organ has fallen. Different types of pelvic organ prolapse can include the following:

Vaginal prolapse (apical prolapse): The top of the vagina dips into your vaginal canal. This usually occurs in people who have had a hysterectomy (removal of the uterus).
Uterine prolapse: the uterus sometimes protrudes or slides so much into the vagina that it comes out of the vaginal opening. In severe cases, you will feel that the vaginal tissue is rubbing against the clothes.
Cystocele: The bladder flows into the vagina.
Urethrocele: The urethra (the tube that carries urine from the bladder) protrudes into the vagina.
Rectocele: The rectum protrudes into the vagina.
Enterocele: The small intestine protrudes against the back wall of the vagina.

How common is vaginal prolapse?

Vaginal prolapse is relatively common, especially among women who have given birth vaginally, experienced multiple pregnancies, or have gone through menopause. Statistics vary, but it’s estimated that around 40% to 50% of women may experience some degree of pelvic organ prolapse in their lifetime. However, the severity and impact on daily life vary widely among individuals.

Symptoms of vaginal prolapse

The symptoms of vaginal prolapse can vary based on the type and severity of the prolapse. Common signs include:

A feeling of pressure or fullness in the pelvic area: This might feel like something is bulging or coming out of the vagina.
Visible bulge: You might notice a bulge or protrusion at the vaginal opening.
Discomfort or pain: This can occur in the pelvic region, lower back, or during sexual intercourse.
Urinary problems: Such as urine leakage (incontinence), frequent urination, or difficulty emptying the bladder.
Bowel issues: Difficulty with bowel movements or a sensation of incomplete emptying after bowel movements.
Issues with sexual activity: Pain or discomfort during intercourse can occur due to the prolapse.

These symptoms can range from mild to severe and might worsen with activities like standing, lifting, or straining. Consulting a healthcare professional is important for an accurate diagnosis and appropriate treatment.

What is the cause of vaginal prolapse?

The vagina is held in place inside the pelvis by a group of muscles and other tissues – creating a kind of support structure. This structure holds the organs in place in the pelvis. Over time, this structure can weaken. When this happens, the vagina may slip out of place, causing prolapse. There can be several common causes of vaginal prolapse.

Childbirth

Vaginal delivery increases the risk of prolapse more than cesarean section. If you have had many natural births, had a long labor, or delivered a large baby (over 9 pounds), your risk of prolapse may be higher.

Menopause

During menopause, the ovaries stop producing the hormones that regulate the menstrual cycle. Estrogen is especially important because it helps keep the pelvic muscles strong. When the body does not produce as much estrogen as before, the pelvic muscles weaken, and you may experience prolapse.

Surgery

People who have had a hysterectomy are more prone to vaginal prolapse.

Aging

As you get older, you are at risk of developing prolapse.

Vigorous physical activity or heavy lifting

The strain from activity can also weaken your pelvic floor muscles, allowing your limbs to slip out of position.

Genetic or hereditary factors

The pelvic support system can naturally be weaker.

Activities or conditions that put more pressure on the abdominal area can cause sagging. These can include the following:

Heavy lifting
Straining to poop
Not maintaining a healthy body weight
Having a chronic cough

Are certain women at greater risk?

Vaginal prolapse is more likely if:

Had a vaginal delivery, especially a complicated delivery
They have gone through menopause
Smoke
They are overweight
Profuse cough due to lung disease
They are chronically constipated and have to strain to have a bowel movement
A family member, such as a mother or sister, has had prolapse
They often lift heavy things
They have fibroids

Diagnosis and tests

Diagnosing vaginal prolapse typically involves a few steps:

Physical Examination: Your healthcare provider will conduct a pelvic exam. During this exam, you’ll likely be asked to bear down as if having a bowel movement or to cough, which helps reveal the extent of the prolapse.
Medical History: Your doctor will ask about your symptoms, medical history, pregnancies, and any surgeries that might be relevant.
Additional Tests: Sometimes, other tests like urodynamic studies (to assess bladder function) and imaging tests such as ultrasound, MRI, or cystoscopy (using a small camera to view inside the bladder) may be recommended, especially if there are concerns about the extent or impact of the prolapse on other organs.

The diagnosis is typically made based on the physical examination, the information obtained from your medical history, and any additional tests if needed. Consulting with a healthcare professional, usually a gynecologist or urogynecologist, is crucial for an accurate diagnosis and appropriate treatment plan.

How is vaginal prolapse treated?

The treatment for vaginal prolapse depends on various factors, including the severity of the prolapse, its impact on your daily life, and your overall health. Here are the common approaches:

Lifestyle Changes: Mild cases may be managed with lifestyle adjustments like pelvic floor exercises (Kegels), weight management, avoiding heavy lifting, and treating conditions contributing to prolapse (like chronic coughing).
Pelvic Floor Therapy: Physical therapy or working with a specialist trained in pelvic floor rehabilitation can strengthen the pelvic floor muscles, potentially reducing symptoms.
Pessary: This is a device inserted into the vagina to support the prolapsed organs. It’s a non-surgical option and can be effective in managing symptoms.
Surgery: Surgical options might be considered for more severe cases or when symptoms significantly impact quality of life. There are various procedures available, including repairs to the vaginal walls, hysterectomy (removal of the uterus), or procedures to suspend or support the pelvic organs. The specific type of surgery depends on the type and severity of the prolapse.

The treatment choice is personalized and should be discussed with your healthcare provider. Before recommending a treatment plan, they’ll consider factors such as your symptoms, overall health, desire for future pregnancies, and personal preferences.

The bottom line

A person with vaginal prolapse may not experience severe symptoms. However, sometimes, vaginal prolapse can lead to problems that require medical treatment. Treatment depends on the severity of the breakdown, the person’s overall health, and the symptoms they are experiencing.

Treatments range from non-invasive lifestyle changes to surgical procedures to repair the damaged area. People should discuss their symptoms and treatment options with their doctor to determine the best option. Although people may not need surgery, certain lifestyle changes can help treat and prevent pelvic organ prolapse. Dr. Arjang Naim can help you in this field.

Additional questions

What happens if prolapse is not treated?

Failure to treat vaginal prolapse can worsen the condition. In addition to more pain, you may have vaginal sores, infections, and an increased risk of damage to other pelvic organs.

How will vaginal prolapse affect sexual intercourse?

Vaginal prolapse can impact sexual intercourse in various ways, but the effects can differ depending on the severity of the prolapse and individual circumstances:

Discomfort or Pain
Reduced Sensation
Emotional Impact
Changes in Libido

Will vaginally prolapse affect the ability to have children?

Vaginal prolapse itself typically doesn’t directly impact the ability to conceive or have children. However, the treatments for vaginal prolapse, particularly surgeries involving the uterus (if present), might affect future pregnancies.

What medications are used to treat vaginal prolapse?

Medications typically aren’t the primary treatment for vaginal prolapse itself. However, they might be prescribed to manage symptoms or conditions that contribute to or accompany prolapse: