Vaginal Prolapse

Vaginal prolapse at a glance

  • A vaginal prolapse refers to a weakness in the tissue around the vagina that causes it to stretch or shift out of place, moving forward or down (prolapse).
  • Approximately one-third of women develop some degree of pelvic organ (vaginal, bladder or uterine) prolapse, although not everyone will experience symptoms.
  • When symptoms are present they may include the sensation that something in the vagina is out of place, pain or pressure in the pelvic area, urine leakage (urinary incontinence) and uncomfortable intercourse.
  • Treatment can include surgical and nonsurgical techniques such as exercises to strengthen the pelvic muscles and a woman’s core.

What is a vaginal prolapse?

A pelvic organ prolapse refers to a weakness around the vagina allowing the uterus, bladder, rectum, urethra, small bowel or — as in the case of vaginal prolapse — the vagina itself to shift outside of their normal positions.

The network of muscles, tissue and skin surrounding a woman’s vagina acts as a complex support structure holding pelvic organs in place. When various parts of this support system weaken, it causes a prolapse.

Vaginal prolapse usually occurs after menopause, childbirth or a hysterectomy and typically after age 40. Some women are unaware of the condition and experience no symptoms, while others experience discomfort, pelvic pressure, uncomfortable intercourse, frequent urination or not being able to control leakage (incontinence).

Treatment depends upon the nature of the vaginal prolapse, if it is impacting other organs and whether symptoms are present and to what degree. Lifestyle changes can often manage or strengthen weakened muscles but surgery is also an option if recommended by a physician.

What are vaginal prolapse causes & symptoms?

Many factors can affect why a woman may or may not develop a vaginal prolapse. Women who have had multiple children by vaginal birth are at greatest risk for vaginal prolapse. Difficult labor can weaken pelvic floor muscles and result in vaginal prolapse. Delivering a large baby can have the same effect.

Other risk factors include surgery to the pelvic floor, obesity, family history, chronic constipation and excessive bearing down in bowel movements, heavy lifting, aggressive exercise, age, chronic coughing and having a neuromuscular disease such as multiple sclerosis.

In most cases, vaginal prolapse is unpreventable. However, woman can reduce risk factors before they result in vaginal prolapse by making lifestyle changes, such as:

  • Losing weight (if obese)
  • Avoiding heavy lifting or straining
  • Getting treated for a chronic cough
  • Performing Kegel exercises which help strengthen the vaginal muscles (although they cannot reverse prolapse)
  • Estrogen therapy which is linked to improvements in vaginal muscle tone
  • Physical therapy to help strengthen the pelvic muscles and a woman’s core.

Symptoms of vaginal prolapse

Vaginal prolapse symptoms vary depending on where the weakness occurs, and some women may not experience any symptoms. Women without signs are often diagnosed during routine gynecological exam.

Otherwise, women most often feel the sensation that something in the vagina is out of place, sometimes accompanied by a protrusion or pressure in the same area. Other symptoms may include:

  • Recurrent urinary tract or bladder infections
  • Pressure or heaviness in the pelvis or vagina
  • Reduced pain or pressure when reclining
  • Painful intercourse
  • A lump or protrusion in the walls of the vagina
  • Enlarged vaginal opening
  • Difficulty inserting tampons
  • Leaking urine when coughing, laughing or exercising
  • Difficulty emptying the bladder or bowels.

Traditionally, the basic check for any pelvic organ prolapse will start with a pelvic exam. Once it is determined a woman has a vaginal prolapse, additional tests may be required such as bladder test to determine the ability of the bladder to eliminate or store urine and an ultrasound.

Treatment options for vaginal prolapse

Urologists use a number of strategies to treat vaginal prolapse based on strengthening the pelvic muscles and reducing symptoms. Some women are candidates for nonsurgical treatment, including women who are not sexually active, cannot undergo surgery, or experience little to no symptoms.

Some women may be treated with a pessary. This is a donut-shaped device inserted into the vagina to hold the uterus in place. Similar to a diaphragm, the pessary can be taken out for regular cleaning and can be used for short-term or long-term support. It is particularly useful for women with pregnancy- and childbirth-related prolapse during their recovery.

Surgery

Vaginal prolapse surgery repairs the vaginal walls and/or vaginal support structure within the pelvis.

Surgical options work to either push organs back into place or secure the vagina using a woman’s existing ligaments or man-made alternatives. The type of surgery greatly depends upon the severity and nature of the vaginal prolapse as well as the patient’s health, age and whether or not she has plans to become pregnant.

Many surgeries are conducted through the vagina and leave no visible scars. When possible, urologists will perform surgery using a laparoscope, a small tube with a video camera inserted into the abdomen through which the surgeon operates with special instruments. This method uses smaller incisions, reducing blood loss and recovery time.

A surgical procedure called anterior colporrhaphy tightens the front walls of the vagina, while posterior colporrhaphy tightens the back walls. Where supporting tissues have been weakened, additional natural or artificial materials (mesh) may be placed to support the repair.

As with any surgery, patients’ recovery and risks vary depending upon their overall health and the extent of surgery. Common surgical side effects and risk include bleeding, pain, swelling and scarring at the incision.

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