Vaginal Prolapse

What Is Vaginal Prolapse?
 
Vaginal prolapse is the weakening or breaking up of organs such as the uterus, rectum, bladder, urethra, small bowel or the vagina. These organs can fall out of their normal positions as a result of a weakening support system, which is comprised of the muscles, ligaments, and skin in and around the vagina.

The following are different types of vaginal prolapses:

• Rectocele – This is a prolapse of the rectum. The back wall of the vagina becomes displaced, causing the rectal wall to push against the vaginal wall. This can result in a bulge.

• Cystocele – This is a displacement of the bladder, also called a bladder drop. This occurs when the front wall of the vagina falls out of place, causing the bladder and possibly the urethra to fall out of place into the vagina.

• Enterocele – This is a prolapse of the herniated small bowel due to the weakening of the upper vaginal supports.

• Prolapsed uterus – This is a prolapse of the womb. It’s caused when a group of ligaments on the top of the vagina weaken. This causes the uterus to fall, which is commonly followed by the debilitation of the front and the back walls of the vagina. There are four degrees of uterine prolapse to denote the position the uterus has fallen within or outside of the vagina.

• Vaginal vault prolapse – This is the falling of the top of vagina into the vaginal opening. This can lead to weakened vaginal walls. Ultimately, the top of the vagina may protrude out of the body through the vaginal opening, turning the vagina inside out. A vaginal vault prolapse may be linked to a hysterectomy and often accompanies an enterocele. 

Vaginal Prolapse Causes

Some common factors of vaginal prolapses can include:

• Childbirth (especially multiple births)
• Menopause
• Hysterectomy
• Age
• Obesity
• Improper functioning of nerves and tissues
• Abnormalities of connective tissue
• Stressful physical activity
• Prior pelvic surgery

Vaginal Prolapse Symptoms

Some of the more common general symptoms can include the following:

• Vaginal or pelvic pressure
• Pain during intercourse
• Lump at vaginal opening
• Decrease in pain or pressure when lying down
• Recurring urinary tract infections

Symptoms that may be linked to specific types of vaginal prolapse can include:

• Difficulty in emptying bowel or bladder
• Constipation
• Urinary stress (leakage during coughing, sneezing or exercise)
• Pain while standing for long time
• Protrusion of vaginal walls
• Enlarged, widened and gaping vaginal opening

How is Vaginal Prolapse diagnosed?

The diagnosis of vaginal prolapse typically involves a medical history and physical examination. The following are tests that a doctor may use to evaluate women:

• Q-tip test
• Bladder function test
• Pelvic floor strength
• Magnetic resonance imaging (MRI) scan
• Ultrasound
• Cystourethroscopy

Vaginal Prolapse Treatment

Most vaginal prolapses can only be fully corrected with surgery. Here are some common treatment options:

• Non-surgical, for sexually inactive women or women who can’t undergo surgery
• Surgical, the most effective of the options, typically recommended for sexually active women
• Self-Care, can include activity modification, a pessary placed in the vagina, and kegel exercises
• Medical treatment, typically consists of estrogen replacement therapy
• Physical therapy, can include electrical stimulation or biofeedback

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