A vaginal prolapse is a weakness around the vagina that allows the uterus, rectum, bladder, urethra, small bowel, or the vagina itself to fall from their normal positions. In and around a woman’s vagina is a support network of muscles, ligaments, and skin, all holding organs, tissues, and structures in place in the pelvis. If parts of this system weaken or break, these can fall, or prolapse, and if neglected they can fall farther and farther into the vagina or even through the vaginal opening.
Vaginal prolapse can affect sexual and bodily functions such as urination and defecation and can also result in pelvic pressure and discomfort as common symptoms. Some women are candidates for nonsurgical treatment, while for many others, surgery is the best option.
Approximately one-third of women develop some degree of vaginal prolapse, usually after menopause, childbirth, or a hysterectomy and usually after age 40. Some do not experience any symptoms, while many women who do experience symptoms are too embarrassed to seek treatment.
The symptoms of prolapse vary depending on the type, and some women experience no symptoms. The most common symptom is the sensation that something in the vagina is out of place, sometimes accompanied by a protrusion or pressure in the same area. General symptoms include:
Symptoms can also be specific to certain types of prolapse:
Very rarely is a woman’s life in danger from a vaginal prolapse, although prolapses usually get worse with time. For this reason, it’s wise to act promptly when symptoms first appear.
The best way to diagnose vaginal prolapse is through a physical examination and a review of the woman’s medical history. Usually a physician examines each section of the vagina separately, requiring the woman to sit upright to make any prolapsed tissues easier to find.
Cystocele or rectocele are more easily discovered by a physical examination than are vaginal vault prolapse or enterocele. The examining physician may use a variety of tests for diagnosis, including a urodynamics procedure, an exam of the urethra-bladder neck, and an investigation of the strength of the pelvic floor.
The urologist may also order a magnetic resonance imaging (MRI) scan, an ultrasound exam or conduct cystourethroscopy, in which a small tube is inserted into the urethra for internal viewing of the urethra and bladder.
Some women are candidates for nonsurgical treatment, including women who are not sexually active, cannot undergo surgery, or experience few symptoms. These women may benefit from estrogen replacement therapy to help strengthen vaginal muscles.
For others, surgery is likely the best option. Today laparoscopic surgery is common for securing the vaginal vault after a hysterectomy and correcting some types of vaginal prolapse such as enteroceles or uterine prolapses.
Physical therapy can help strengthen the muscles in the pelvis of a sufferer of vaginal prolapse. There are two kinds:
Surgical treatments for vaginal prolapse vary with the type of prolapse and usually require from two to four days of hospitalization. After surgery, a patient should avoid heavy lifting for from six weeks to two months.
A surgeon operating for cystocele and rectocele works through the vagina, usually with an incision in the vaginal wall in order to push the organ up and back into place. The surgeon then secures the vaginal wall to fix the organ in its normal position and next removes any excess tissue before closing the vaginal wall. If the patient is suffering from urinary incontinence, the surgeon may need to support the urethra through a procedure called a bladder neck suspension.
For vaginal vault prolapse, which takes place high in the vagina, a surgeon may work through either the vagina or abdomen, the latter being for severe cases. In most surgeries of this type, the surgeon uses a technique called a vaginal vault suspension, in which the vagina is attached to strong tissue in the pelvis or to the sacrum, a bone at the base of the spine.
In the case of a prolapsed uterus, women who are postmenopausal or do not want to have more children usually undergo a hysterectomy. The common approach for this procedure is through the vagina.
Contact us to learn more about diagnosis and treatment options for vaginal prolapse or to schedule an appointment with our board certified urologists.