Vaginal Prolapse (Pelvic Organ Prolapse): Causes, Symptoms and Treatment
Vaginal prolapse (pelvic organ prolapse) is when the bladder, womb, bowel or the top of the vagina moves down into the vagina or towards its opening because the muscles and connective tissues that support them have weakened. Mild prolapse may cause no symptoms; in advanced prolapse, tissue may bulge out of the vaginal opening. This article explains the types of vaginal prolapse, its causes, symptoms and treatment options.
Types of Vaginal Prolapse
- Front wall prolapse (cystocele): the bladder bulging into the front wall of the vagina
- Back wall prolapse (rectocele): the last part of the large bowel bulging into the back wall of the vagina
- Uterine prolapse: the womb moving down into the vagina
- Vaginal vault prolapse: the top of the vagina moving down in people who have had their womb removed
Several of these types can occur at the same time.
Sagging of the Labia Is a Different Condition
Enlargement or sagging of the outer or inner lips (labia majora and labia minora) is not caused by pelvic organs moving out of place, so it should not be confused with vaginal prolapse. Complaints related to the inner lips can be treated with labiaplasty, and vaginal laxity after childbirth with vaginal tightening; for details you can read our article Vaginal Tightening (Vaginoplasty): Who Is It Suitable For?.
Causes
- Vaginal birth, especially multiple, prolonged or assisted births
- Lower oestrogen levels with menopause, and ageing
- Excess weight
- Conditions that increase pressure in the abdomen, such as a chronic cough, chronic constipation and frequent heavy lifting
- Connective tissue that is weak from birth
- Previous pelvic operations such as removal of the womb
Symptoms
- A feeling of heaviness, fullness or pressure pushing down in the vagina or lower abdomen
- A bulge that can be felt or seen at the vaginal opening
- Urinary leakage, a feeling of not emptying the bladder fully or needing to pass urine often
- Difficulty opening the bowels
- Discomfort during sexual intercourse
Symptoms usually get worse after standing for a long time or at the end of the day.
Diagnosis
The diagnosis is made through a gynaecological examination; the type and degree of prolapse are assessed while the person bears down. If necessary, an ultrasound or tests that assess urinary function (urodynamics) may be done. The diagnosis and treatment of vaginal prolapse are planned by an obstetrician-gynaecologist or a doctor working in urogynaecology.
Treatment Options
Treatment is decided according to the type and degree of the prolapse, the symptoms, age, plans for pregnancy and general health.
- Monitoring and lifestyle changes: For mild prolapse that causes no symptoms, monitoring may be enough; weight control, preventing constipation and avoiding heavy lifting are recommended.
- Pelvic floor muscle exercises: These can help reduce symptoms in mild and moderate prolapse; they are more effective when done with a physiotherapist.
- Pessary: A silicone ring placed in the vagina to support the organs; it can be used by people who do not want surgery or are not suitable for it.
- Local treatment in menopause: If the doctor considers it necessary, local medicines that support the vaginal tissue may be recommended.
- Surgery: For people whose symptoms affect daily life and who do not benefit from other methods, operations that repair the weakened supporting tissues may be performed; the type of operation is decided by the gynaecologist.
Health authorities have warned that there is not enough evidence on the safety and effectiveness of using laser and other energy-based devices for vaginal rejuvenation and similar purposes; for details you can read our laser vaginal rejuvenation page.
Can It Be Prevented?
Vaginal prolapse cannot always be prevented; however, pelvic floor muscle exercises, maintaining a healthy weight, preventing constipation with a high-fibre diet and enough fluids, stopping smoking and using the right technique when lifting heavy objects can help reduce the risk. For how to do the exercises you can read our article Pelvic Floor Muscle Exercises (Kegel): How to Do Them and Who They Are For.
Author: Op. Dr. Yücel Sarıaltın