Vaginal Prolapse: What You Need to Know

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Vaginal prolapse is a condition where the top of the vagina falls from its normal position in the body. This happens when the muscles and tissues that support the pelvic organs become weak or stretched. Vaginal prolapse can cause discomfort, pressure, urinary problems and sexual difficulties.

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What Causes Vaginal Prolapse?

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The main cause of vaginal prolapse is damage to the pelvic floor muscles and ligaments. The pelvic floor is a network of muscles, tissues and organs that support the bladder, uterus, vagina, rectum, and urethra. The pelvic floor can be weakened by:

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• Pregnancy and childbirth, especially multiple births or large babies
• Ageing and menopause, which reduce the levels of oestrogen that help maintain the strength and elasticity of the pelvic tissues
• Obesity, which increases the pressure on the pelvic floor
• Chronic coughing, sneezing or straining due to asthma, smoking, allergies or constipation
• Heavy lifting or intense physical activity
• Previous pelvic surgery or injury

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What are the Symptoms of Vaginal Prolapse?

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The symptoms of vaginal prolapse depend on the severity and type of prolapse. There are different types of prolapse that affect different organs in the pelvis. These include:

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• Uterine prolapse: The uterus drops into the vagina, sometimes protruding outside the vaginal opening
• Cystocele: The bladder bulges into the front wall of the vagina
• Urethrocele: The urethra (the tube that carries urine from the bladder) sags into the front wall of the vagina
• Rectocele: The rectum pushes into the back wall of the vagina
• Enterocele: The small intestine bulges into the upper part of the vagina

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Some Common Symptoms of Vaginal Prolapse

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• A feeling of heaviness, fullness or pressure in the pelvis and vagina
• A bulge or lump in the vagina that can be seen or felt
• Difficulty emptying the bladder or bowel completely
• Frequent urinary tract infections or leakage of urine (incontinence)
• Constipation or difficulty passing stool
• Pain or discomfort during sex or reduced sexual sensation
• Lower back pain or pelvic pain

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How is Vaginal Prolapse Diagnosed?

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To diagnose vaginal prolapse, your doctor will ask you about your medical history, symptoms, and lifestyle factors. They will also perform a physical examination of your pelvis, including a speculum exam to look inside your vagina and a pelvic exam to feel your organs. They may also ask you to cough, bear down or lift your legs to see how your pelvic organs move.

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Your doctor may also order some tests to check your bladder and bowel function, such as:

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• Urinalysis: A test of your urine sample to look for signs of infection or blood
• Urodynamic tests: Tests that measure how well your bladder stores and empties urine, such as cystometry (measuring bladder pressure) or uroflowmetry (measuring urine flow rate)
• Defecography: An X-ray test that shows how well you empty your bowel

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How is Vaginal Prolapse Treated?

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The treatment for vaginal prolapse depends on the type and severity of prolapse, your symptoms, your age, your general health, and your personal preferences.

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Some possible treatment options are:

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• Lifestyle changes: These include losing weight if you are overweight, quitting smoking if you smoke, avoiding heavy lifting or straining, treating chronic coughing or constipation, doing pelvic floor exercises (also known as Kegel exercises) to strengthen your muscles and using oestrogen cream or tablets if you are postmenopausal.

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• Pessary: A pessary is a device that is inserted into your vagina to support your pelvic organs. It can be made of silicone, rubber or plastic and come in different shapes and sizes. You may need to remove it regularly to clean it and prevent infection. A pessary can help reduce your symptoms and improve your quality of life without surgery.

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• Surgery: Surgery is usually reserved for severe cases of prolapse that do not respond to other treatments or cause significant problems. There are different types of surgery for vaginal prolapse, such as:

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• Vaginal repair: This involves stitching together the weakened tissues in your vagina to lift up your organs. This can be done through an incision in your vagina (vaginal approach) or through an incision in your abdomen (abdominal approach).

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• Hysterectomy: This involves removing your uterus if it is part of the prolapse. This can be done through an incision in your vagina (vaginal hysterectomy) or through an incision in your abdomen (abdominal hysterectomy).

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• Mesh repair: This involves using a synthetic mesh material to reinforce your tissues and support your organs. This can be done through an incision in your vagina (transvaginal mesh) or through an incision in your abdomen (transabdominal mesh). Mesh repair is not recommended as a first-line treatment due to the risk of complications, such as infection, erosion, pain and sexual dysfunction.

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• Sacrocolpopexy: This involves attaching your vagina to your sacrum (the bone at the base of your spine) with a mesh material to lift up your organs. This is done through an incision in your abdomen (open sacrocolpopexy) or with small incisions and a camera (laparoscopic or robotic sacrocolpopexy).

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The choice of surgery depends on your individual situation and your doctor's expertise. Surgery can improve your symptoms and quality of life, but it also has some risks and complications, such as bleeding, infection, nerve damage, recurrence of prolapse or new problems with bladder, bowel or sexual function. You should discuss the benefits and risks of surgery with a doctor before making a decision.

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What are the Complications of Vaginal Prolapse?

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Vaginal prolapse can affect your physical and emotional well-being. Some possible complications of vaginal prolapse are:

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•  Urinary problems: These include difficulty emptying your bladder, urinary incontinence, urinary tract infections or kidney damage due to urine retention.
• Bowel problems: These include difficulty emptying your bowel, faecal incontinence, constipation or haemorrhoids.
• Sexual problems: These include pain, discomfort, reduced sensation or difficulty having sex.
• Infection: This can occur if you have a pessary that is not cleaned properly or if you have a mesh repair that erodes into your tissues.
• Ulceration: This can occur if you have a severe prolapse that protrudes outside your body and rubs against your clothes or skin.
• Psychological distress: This can occur due to the impact of prolapse on your self-esteem, body image, relationships and quality of life.

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How Can I Prevent Vaginal Prolapse?

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You may not be able to prevent vaginal prolapse completely, but you can reduce your risk by taking some steps to protect your pelvic floor health. These include:

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• Doing pelvic floor exercises regularly to strengthen your muscles
• Maintaining a healthy weight and avoiding obesity
• Quitting smoking and avoiding chronic coughing
• Treating constipation and avoiding straining
• Avoiding heavy lifting or intense physical activity
• Seeking medical attention for any symptoms of prolapse

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Sources

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- Debbo Africa: https://debbo.africa

- Cleveland Clinic. Vaginal Prolapse. https://my.clevelandclinic.org/health/diseases/17597-vaginal-prolapse

- Mayo Clinic. Anterior vaginal prolapse (cystocele). https://www.mayoclinic.org/diseases-conditions/cystocele/symptoms-causes/syc-20369452

- Johns Hopkins Medicine. Vaginal Prolapse. https://www.hopkinsmedicine.org/health/conditions-and-diseases/vaginal-prolapse

- The Royal Women's Hospital. Vaginal prolapse. https://www.thewomens.org.au/health-information/vaginal-prolapse

- NHS. Pelvic organ prolapse. https://www.nhs.uk/conditions/pelvic-organ-prolapse/