Vaginal Prolapse

Vaginal prolapse, in which the muscles and ligaments that support the vagina weaken, is a common condition. When the vagina can no longer be supported, it shifts downward from its normal position, typically causing pressure, stretching and pain. In severe cases, tissue may actually protrude from the vagina.

Types of Vaginal Prolapse

Vaginal prolapse has four basic types, each characterized by the bulging (herniation) of another organ into the vagina. Each type, listed below, has slightly different symptoms:

• Rectocele
• Cystocele
• Enterocele
• Vaginal-vault prolapse

With rectocele, the front wall of the rectum bulges into the vagina; with cystocele, the bladder bulges into the vagina; with enterocele, the small intestine bulges into the vagina; and with vaginal-vault prolapse, the wall of the vagina itself prolapses.

Causes of Vaginal Prolapse

Vaginal prolapse is most often caused by the strain placed on the pelvic muscles during childbirth; vaginal deliveries typically stretch or weaken the pelvic muscles. Other factors that put pressure on the pelvis, and can lead to vaginal prolapse, include the following:

• Obesity
• Chronic cough
• Frequent constipation
• Tumors in the area
• Hysterectomy

Aging, menopause, and the deterioration of nerves and muscles over time also contribute to the loss of pelvic floor strength, and the possible development of vaginal prolapse.

Symptoms of Vaginal Prolapse

Women with vaginal prolapse typically experience the following symptoms:

• Incontinence
• Frequent urination
• Pain during intercourse

Women suffering from vaginal prolapse may also have difficulty emptying their bladders or bowels thoroughly.

Diagnosis of Vaginal Prolapse

A doctor can usually diagnose vaginal prolapse by performing physical and pelvic examinations, reviewing symptoms, and taking a medical history that includes information about past pregnancies. In addition, the following tests may be performed:

• X-rays
• Ultrasound
• Fluoroscopy
• Bladder-function test
• MRI scan
• Cystourethroscopy
• Cystoscopy

During a pelvic-floor examination, the patient may be required to sit upright and strain, bearing down, so that any prolapsed tissue becomes more apparent to the physician. Cystocele or rectocele are more easily identifiable during the physical examination than vaginal-vault prolapse or enterocele.

Treatment for Vaginal Prolapse

Treatment for vaginal prolapse varies depending on the symptoms the patient is experiencing, and the severity of the displacement. Conservative methods of treatment are usually recommended initially but, in many cases, other methods of treatment are necessary. More severe cases of vaginal prolapse may require surgery to repair damaged tissue, and reposition the vagina.

Conservative Methods

Patients with mild symptoms can often treat themselves at home by performing Kegel exercises that strengthen the pelvic muscles. Losing weight, stopping smoking and avoiding strenuous activities may also help.

Pessary Device

Cases of vaginal prolapse that do not respond to conservative treatments may require a pessary, a small device that is inserted into the vagina to relieve pain and pressure, and hold the organs in place. The patient is taught how to insert and remove the pessary.

Surgical Repair

Surgery to repair vaginal prolapse can be performed with a minimally invasive laparoscopic procedure through the abdomen. The surgeon begins by repairing defects of the pelvic floor muscles, and restoring the anatomical structures involved. The vagina and any other organs that have shifted are repositioned. The vagina is held in place using stitches that attach it to the adjacent ligaments or tissues. The vaginal abnormality is then repaired using a skin graft or synthetic mesh.

Left untreated, symptoms of vaginal prolapse typically worsen, so it is best to treat them as soon as possible.