Vaginal prolapse types, symptoms, causes and treatment

Vaginal prolapse is the dropping of the vagina or/and uterus. It's very common, particularly in women who’ve had children and who have gone through menopause, and while it’s not dangerous, it can affect your quality of life. Ms Sameena Muzaffar, a leading consultant gynaecologist obstetrician, provides you with a detailed explanation to help you in finding a solution to your discomfort.

What is vaginal prolapse?

Different women can have different degrees of prolapse and different types of prolapse. You can have:

• Prolapse of the womb/uterus
• Posterior vaginal wall prolapse (also known as bowel prolapse) - as the posterior wall of the vagina descends inside the vaginal cavity, the bowel also descends into the vaginal cavity
• Anterior vaginal wall prolapse (also known as bladder prolapse)

What are the causes?

A prolapse happens because of the weakness of the pelvic floor muscles and the connective tissue around it.

The main causes of vaginal prolapse are:

• Childbirth
• Menopause

When these happen, the pelvic floor muscles and the connective tissue around them become weak. The pelvic floor muscles are like a trampoline that holds womb, vagina, bladder and bowels up. Once we have children or we go through the change, it becomes like a hammock. The result is that the womb, bladder and bowels drop down, which we call a prolapse.

Posterior vaginal wall (bowel) prolapse can be really uncomfortable, particularly when your bowels are full. It’s caused by a weakness of the pelvic floor muscles and it's common in women with chronic constipation because when you're trying to open your bowels while constipated, it pushes the wall of the vagina and causes prolapse.

Chronic cough and being overweight can also lead to prolapse. If your weight is on the higher side; that is the first thing we need address: you need to reduce your weight to prevent the prolapse from getting worse and causing problems.

What are the symptoms?

The symptoms of prolapse are quite variable. They depend on the degree of the prolapse and the type of prolapse you have. A common symptom is feeling as if you're sitting on an egg. This is how women commonly describe it, and it’s usually towards the end of the day or if they have opened their bowels.

Some women will have no symptoms at all and the prolapse is incidentally found during an examination, particularly during the cervical smear.

Common symptoms of prolapse are:

• A dragging sensation in the vagina
• Fullness in the vagina
• Discomfort in the vagina in general
• Discomfort in the vagina during sexual intercourse

If you have an anterior vaginal wall (bladder) prolapse, you can also have symptoms such as:

• Difficulty in emptying your bladder. When trying to, you feel that you can’t empty it completely and once you get up, you dribble a little bit.
• Urinating too often during the daytime and night time.
• Feeling urgency to urinate and rushing to the toilet.
• You may sometimes need to push your finger inside the vagina to reduce the prolapse to enable you to empty your bladder.

If you have a posterior vaginal wall (bowel) prolapse, you may also have:

• Difficulty emptying your bowels.
• If the posterior vaginal wall prolapse is big, once you try to empty your bowels, you'll find at the bowels instead of coming out, it goes into this pouch, and some women put their finger inside the vagina to facilitate emptying of bowels, which we call as digitation to defecate.

Very occasionally, prolapse can cause bleeding when it's outside the vagina and it's rubbing on the underwear.

How is it treated?

There are different ways of treating the prolapse and it’s not always necessary to have medical treatment. But I would suggest seeing your GP if you suspect that you have a prolapse because they will discuss the treatment options with you.

If your prolapse is not causing any symptoms and is not coming out completely, your GP will recommend you do pelvic floor exercises. This will not repair the prolapse but it will prevent it from getting worse. If you're overweight, they will advise you to lose weight.

If your prolapse is causing symptoms, you will likely be offered treatment: either a pessary or surgery. A pessary is a vaginal device that is placed inside the vagina to hold everything up. They can be put in by your GP, or the GP can send you to the hospital to see a urogynecologist. Pessaries involve hardly any complications but need to be changed every six weeks.

If your doctor does not recommend a pessary or if you don’t want it, then you may be referred for surgery. Surgeries for prolapses are quite simple, they are not very high risk, you recover quickly from them and the outcomes are quite good.

Seek medical assistance

There's no reason why women should consider prolapse as a simply part of being a woman. They should come and see their doctor to get it assessed and treated because this will improve their quality of life.

Ms Muzaffar is a well-known expert in several aspects of gynaecology, including vaginal prolapses. Click here to discover how she can help you look after your health.