Vaginal Prolapse

Vaginal prolapse is a condition in which the muscles supporting the muscles in the pelvis weaken and stretch, allowing the bladder, uterus and or bowel to protrude into the vagina. The condition rarely involves the vagina alone. This protrusion can cause complications such as abdominal pain, problems with bowel movements, issues with urinary function and even difficult sexual intercourse.

Many women experience symptoms like constipation and difficulty with full bowel or bladder elimination. Some women describe feeling the sensation of a lump in the vagina. Other common complaints include difficulty with tampon use (or the inability to use a tampon altogether), vaginal dryness or irritation and pain with intercourse. Symptoms often progress very slowly, with sufferers making gradual and potentially detrimental lifestyle and social changes to accommodate these symptoms which may go unnoticed until they become extreme.

There are three types of vaginal prolapse: anterior vaginal wall prolapse (cystocele or urethrocele), posterior wall prolapse (rectocele or enterocele), and apical prolapse (vaginal vault prolapse) or uterine prolapse.

Many women with prolapse are asymptomatic (do not experience symptoms) until an organ has moved further into the vagina.

If the prolapse has moved significantly, symptoms may include:

• A feeling of fullness or discomfort in the vagina which is relieved when lying down.
• A heavy or dragging feeling in the vagina which may be more noticeable during sneezing or coughing, prolonged standing, and/or atypical physical exertion.
• A visible lump in, or outside, the vagina.
• Achiness or pain in the pelvic region or low back.
• Urinary or bowel incontinence.
• Frequent urination, incomplete bladder evacuation, or accidental bladder leaks.
• Recurring urinary tract infections.
• Discomfort or decreased sensation during sexual intercourse.

The most significant cause of vaginal prolapse is pregnancy and vaginal childbirth: almost 1 out of every 2 individuals who have been pregnant will experience some type of prolapse. This is a result of the fact that the pelvic floor is weakened during pregnancy due to extra weight and hormone changes. This is again exacerbated during childbirth, especially if there have been multiple births, the baby was large, or if there was prolonged labor.

Common risk factors for prolapse include:

• A family history of prolapse
• Low levels of estrogen due to menopause
• Being overweight
• Chronic coughing from asthma, smoking and respiratory disease
• Chronic straining due to constipation
• Heavy lifting
• Fibroids or a pelvic tumor
• Previous surgeries to treat vaginal prolapse

Vaginal prolapse is diagnosed by a doctor. Asymptomatic women are typically diagnosed during routine gynecological examinations. A physician specializing in gynecology will typically diagnose a woman experiencing symptoms through a physical exam and a thorough review of her medical history.

The kind of treatment required will depend upon which type of prolapse has occurred, which stage the prolapse is in, age, health, medical history, and future family planning.

There are many different available treatment options from more conservative approaches which may include pelvic floor exercises to strengthen the muscles involved in prolapse. Lifestyle changes may be discussed to avoid making the prolapse more severe, including losing weight, quitting smoking, eating and drinking differently, and lifting less.

For women whose age or physical condition may prevent the implementation of pelvic exercises, a small vinyl or silicone ring (pessary) may be inserted into the vagina to hold the prolapse in place. For cases of prolapse in which the pelvic floor has been stretched or torn, surgery may be the right option. There are several types of prolapse, all of which aim to fix the prolapse and prevent further stretching or damage.

Treatment is not always successful, and sometimes, a prolapse will return.

If you think you are suffering from vaginal prolapse, Advanced Gynecology is here for you.

Our board-certified team of women’s health experts are ready to help you with diagnostic care and a range of treatment options.

We will counsel you about the best options for you and your health.