What is the difference between vaginal prolapse and uterine prolapse?

Vaginal prolapse is, unfortunately, quite the common pelvic-affecting condition amongst women, and is characterised by the organ-supporting muscles in the woman's pelvis becoming weak, leading to one or more of these organs bulging into, and occasionally, out of the vagina. 

In our latest article, revered Cambridge-based consultant urogynaecologist, Miss Nadia Rahman, describes in detail what exactly vaginal prolapse is, and explains the difference between the condition and uterine prolapse. 

What exactly is vaginal prolapse?

Vaginal prolapse is essentially weakness of the structure of vaginal walls that leads to vaginal prolapse. This may or may not include the uterus. Women present with a feeling of a vaginal bulge or something coming down or out the vagina. It is important to remember that the bulge that is visible or felt is not the bladder or the bowels, but rather the vaginal walls. 

What is the difference between vaginal prolapse and uterine prolapse?

The main difference is that one is specifically prolapsed vaginal walls while the other is prolapse of the womb/uterus which happens to sit at the uppermost end of the vagina. Whether it is one or the other, or a combination of both, this can be determined through an examination. Vaginal prolapse can occur from the front and/or back vaginal walls. 

How dangerous can these conditions be if they are left untreated?

Vaginal prolapse is a benign condition but can have a significant impact on a woman’s quality of life. Some women find it embarrassing to seek medical advice and continue carrying on with business as usual. However, if the prolapse continues to increase in size, it can cause difficulty in passage of urine. Larger prolapses can lead to backflow of urine into the kidneys and result in major infection of the kidneys or general body, which is called sepsis.

How are vaginal prolapse and uterine prolapse treated effectively?

I think it is really important to understand what steps can be taken, firstly to reduce the risk of prolapse, and that is how one can self-treat even before the full-blown effects of prolapse have set in. This can be achieved by three very important lifestyle changes. Maintaining a body mass index of under 30 is ideal, so engagement in a weight loss programme or physical activity is highly recommended.

Secondly, they can be effectively treated by avoiding excessive straining on the pelvic floor. This includes improving pre-existing conditions such as constipation, obstructive lung disease, as well as quitting smoking. Lastly, pelvic floor exercises aid women’s understanding of where the pelvic floor is located and how best to exercise it.

Treatment can be a wait and watch approach versus conservative versus surgical with careful discussion of pros and cons of all available procedures available. The conservative route involves a trial of a support device (pessary) with rare risks and an attractive solution due to this very reason. Surgery entails strengthening the weakness in the vaginal walls with the help of stitches and trimming the part of the vagina that is bulging out. A hysterectomy may be required. 

When is surgery required for these cases?

Surgery should be reserved as a final resort and requires an open and honest detailed discussion regarding risks, benefits, success, recurrence, expectations, what is achievable and what is not achievable if surgery is the chosen route. Prolapse surgery is for an entirely benign condition, and thus, the surgery itself is elective and I practice a thorough and deliberated process before coming to the decision of surgery.

There is no ‘one-size-fits-all’ approach and care is tailored as per my patient’s needs. This information gathering process is invaluable for me to gain a full understanding of my patient’s physical function and mental well-being. 

Miss Nadia Rahman is a highly skilled and trusted consultant urogynaecologist who specialises in vaginal prolapse. Consult with her today via her Top Doctors profile if you are currently suffering from any of the symptoms mentioned in the above article.