What is the difference between vaginal prolapse and uterine prolapse?

Written by: Miss Nadia Rahman
Edited by: Conor Lynch

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.

By Miss Nadia Rahman
Obstetrics & gynaecology

Miss Nadia Rahman is a renowned Consultant Urogynaecologist who offers private care to patients at the Spire Cambridge Lea Hospital.

Miss Nadia Rahman's main areas of expertise include the management of female pelvic floor dysfunction that manifests as vaginal prolapse, genuine stress incontinence, mixed urinary incontinence, recurrent urinary tract infections and painful bladder syndrome

Miss Rahman's surgical expertise involves non-mesh procedures only: anterior vaginal wall repair, posterior vaginal wall repair, perineorrhaphy, vaginal hysterectomy, sacrospinous hysteropexy and sacrospinous fixation of the vault in women post-hysterectomy.

She specialises in bladder investigations such as Urodynamics test, cystoscopy and procedures such as intravesical Botox injections and urethral bulkamid injections. She also specializes in general gynaecology procedures such as Bartholin's cysts, vaginal cysts, scarring of vaginal introitus post childbirth, endometrial polyps, and contraception such as Mirena coil insertion and laparoscopic sterilization. 

Miss Rahman is committed to providing holistic and sensitive care to patients with vaginal prolapse, recurrent urinary tract infections, female urinary incontinence and other gynaecological concerns. She fully understands that these issues are often strongly associated with anxiety, embarrassment and can be difficult topics of discussion. She aims to educate as well as improve the quality of life of patients by applying sound clinical skills with a positive demeanour to aid in treatment and management of physical symptoms.

As an expert in her field, she manages expectations of treatment though educating, counselling, focusing on conservative measures and where appropriate, discusses the relevance of surgery.

In her 12 years service in the NHS, she has performed over 180 pelvic floor repairs (anterior +/- posterior colporrhaphy), 70 intravesical Botox/ urethral bulkamid procedures, over 80 vaginal hysterectomies / sacrospinous hysteropexy / sacrospinous fixation and over 100 diagnostic cystoscopy procedures. She is a trained urodynamicist and conducts and analyses tests regularly.

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