Vaginal prolapse: How does it happen, and how is it treated?

Vaginal prolapse occurs when the pelvic organs, such as the bladder, uterus or rectum, descend into or outside the vaginal canal due to weakened pelvic floor muscles and connective tissue. This condition is common among women, particularly after childbirth, menopause or surgery such as a hysterectomy.

What causes vaginal prolapse?

Vaginal prolapse develops due to a loss of support from the pelvic floor muscles and ligaments. Several factors can contribute to this weakening, including:

• Pregnancy and childbirth – Vaginal deliveries, particularly those involving forceps or prolonged labour, can stretch and weaken the pelvic muscles.
• Menopause – Oestrogen levels decline after menopause, reducing tissue elasticity and support.
• Chronic pressure on the pelvic floor – Repeated straining from constipation, chronic coughing, obesity, or heavy lifting can weaken pelvic structures.
• Previous pelvic surgery – Procedures such as a hysterectomy may alter pelvic support, increasing the risk of prolapse.
• Genetic predisposition – Some women have naturally weaker connective tissues, making them more prone to prolapse.

What are the symptoms of vaginal prolapse?

The severity of symptoms varies depending on the degree of prolapse. Common signs include:

• A sensation of heaviness or pressure in the pelvis
• A visible or palpable bulge in the vaginal opening
• Discomfort or pain during intercourse
• Difficulty urinating or having a bowel movement
• Lower back pain or discomfort when standing for long periods

How is vaginal prolapse treated?

Treatment depends on the severity of the prolapse and the impact on daily life. Options include both non-surgical and surgical approaches.

Non-surgical treatments

• Pelvic floor exercises (Kegels) – Strengthening the pelvic muscles can improve support and reduce mild prolapse symptoms.
• Pessary devices – A silicone or plastic device inserted into the vagina can provide structural support and relieve symptoms.
• Lifestyle modifications – Weight management, avoiding heavy lifting, and treating chronic cough or constipation can help prevent further progression.
• Hormone therapy – Oestrogen replacement (topical vaginal creams or rings) may help maintain vaginal tissue strength, particularly in postmenopausal women.

Surgical treatments

When symptoms are severe or non-surgical treatments are ineffective, surgery may be recommended. Options include:

• Vaginal repair (colporrhaphy) – The weakened vaginal wall is reinforced using sutures. We no longer insert any vaginal meshes.
• Sacrocolpopexy – A minimally invasive/open abdominal procedure using mesh to support the vagina and prevent further prolapse.
• Vaginal Hysterectomy (if uterine prolapse is present) – The uterus may be removed to alleviate symptoms and improve pelvic support.
• Sacrospinous fixation- A procedure to support the top the vagina to sacrospinous ligament. This is done vaginally.

The choice of treatment depends on the type of prolapse, a patient’s overall health, and future plans, such as pregnancy considerations. Consulting a specialist can help determine the most suitable approach for each individual.