A guide to understanding vaginal prolapse

Leading consultant gynaecologist Mr Michael Negus discusses vaginal prolapse, and answers some of the most commonly-asked questions about the condition in this comprehensive article.

What is vaginal prolapse?

Vaginal prolapse, also known as pelvic organ prolapse, occurs when the muscles and tissues that support the pelvic organs weaken, causing one or more of the pelvic organs (such as the bladder, uterus, or rectum) to bulge or drop into the vaginal canal. This condition can result in uncomfortable symptoms and affect a woman's quality of life.

What causes vaginal prolapse?

Vaginal prolapse can be caused by various factors, including:

Childbirth: The strain of childbirth, particularly multiple vaginal deliveries or delivering large babies, can weaken the pelvic floor muscles and lead to prolapse.

Age: The natural aging process can cause weakening and stretching of the pelvic floor muscles and connective tissues, increasing the risk of prolapse.

Chronic coughing: Conditions such as chronic obstructive pulmonary disease (COPD) or frequent coughing due to smoking can contribute to pelvic floor muscle weakness and prolapse.

Obesity: Excess weight can put pressure on the pelvic organs and pelvic floor muscles, leading to prolapse.

Hormonal changes: Reduced levels of oestrogen during menopause can result in thinning and weakening of the vaginal tissues, making them more susceptible to prolapse.

What are the symptoms of vaginal prolapse?

Symptoms of vaginal prolapse can vary depending on the severity and type of prolapse but may include:

1. Feeling of vaginal fullness or pressure:

Many women with vaginal prolapse experience a sensation of heaviness, pressure, or fullness in the vagina, particularly after standing for long periods or engaging in strenuous activities.

2. Bulging or protrusion from the vagina:

In more advanced cases of prolapse, women may notice a bulge or lump protruding from the vaginal opening, which may be accompanied by discomfort or pain.

3. Pelvic discomfort or pain:

Some women may experience pelvic pain or discomfort, especially during intercourse or when inserting tampons.

4. Urinary symptoms:

Vaginal prolapse can lead to urinary symptoms such as urinary incontinence (leakage of urine), urinary urgency, frequent urination, or difficulty emptying the bladder completely.

5. Bowel symptoms:

Women with vaginal prolapse may also experience bowel symptoms such as constipation, straining during bowel movements, or difficulty controlling bowel movements.

How is vaginal prolapse diagnosed?

1. Medical history and physical examination:

A healthcare provider will review the patient's medical history and perform a pelvic examination to assess for signs of prolapse and evaluate the severity of the condition.

During the pelvic exam, the provider may ask the patient to bear down as if having a bowel movement to assess the extent of prolapse.

2. Additional tests:

In some cases, additional tests such as urodynamic studies, cystoscopy, or imaging studies (such as pelvic ultrasound or magnetic resonance imaging) may be ordered to evaluate the function of the bladder and assess for other pelvic abnormalities.

What are the treatment options for vaginal prolapse?

Conservative measures

For mild cases of vaginal prolapse, conservative treatment options may include pelvic floor exercises (Kegel exercises), lifestyle modifications (such as weight loss and smoking cessation), and the use of pessaries (removable devices inserted into the vagina to support the pelvic organs).

Surgical intervention

In more severe cases of vaginal prolapse or when conservative measures fail to provide adequate relief, surgical intervention may be recommended.

The goal of surgery is to repair and restore the pelvic floor anatomy, alleviate symptoms, and improve quality of life.

Surgical options for vaginal prolapse include:

Vaginal repair: Traditional vaginal repair surgery involves tightening and reinforcing the pelvic floor muscles and tissues to provide support for the prolapsed organs.

Minimally invasive procedures: Minimally invasive techniques, such as laparoscopic or robotic-assisted surgery, may be performed to repair vaginal prolapse with smaller incisions and faster recovery times.

Mesh surgery: In some cases, synthetic mesh may be used to reinforce the repair and provide additional support to the pelvic organs. However, the use of mesh implants has been associated with complications and is not suitable for all patients.

What are the risks and complications of vaginal prolapse surgery?

Infection:

Like any surgical procedure, vaginal prolapse surgery carries a risk of infection at the incision site or within the pelvic cavity.

Bleeding:

Excessive bleeding during or after surgery may occur, requiring additional interventions to control bleeding.

Urinary or bowel problems:

Surgery for vaginal prolapse may result in urinary or bowel complications, such as urinary incontinence, urinary retention, or difficulty emptying the bladder or bowel.

Mesh-related complications:

If mesh is used during prolapse surgery, there is a risk of mesh-related complications, including mesh erosion, infection, pain, and recurrence of prolapse.

Sexual dysfunction:

Some women may experience changes in sexual function or sensation following vaginal prolapse surgery, although these effects are usually temporary and improve over time.

Vaginal prolapse is a common condition that can cause discomfort and affect a woman's quality of life. With appropriate diagnosis and treatment, including conservative measures or surgical intervention, many women can find relief from their symptoms and regain normal pelvic function. It’s essential for patients to discuss their symptoms and treatment options with a qualified healthcare provider to determine the most appropriate management plan for their individual needs.

Do you require expert attention for vaginal prolapse? Arrange a consultation with Mr Negus via his Top Doctors profile.