Introduction
Vaginal prolapse occurs when the muscles, ligaments, and tissues that support the pelvic organs stretch and weaken. This weakening allows the pelvic organs like the urethra, bladder, uterus, or rectum to drop down into the vagina.
What Are the Types of Vaginal Prolapse?
Depending on the organs involved in the prolapse, vaginal prolapse is classified into five types.
They are as follows:
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Uterine Prolapse - When the uterosacral ligaments at the top of the vagina weaken, the uterus falls, causing both the front and back walls of the vagina to weaken.
There are four different stages of uterine prolapse.
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Vaginal Vault Prolapse - This happens when the top of the vagina slowly falls toward the vaginal opening, causing the walls of the vagina to weaken as well. In time, the top of the vagina may pop out of the body through the vaginal opening, leading to the vagina inside out. An enterocele often accompanies it.
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Cystocele - When the front wall of the vagina prolapses, the urinary bladder may prolapse into the vagina. This may cause the urethra to prolapse as well.
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Urethral Prolapse - It is also called a urethrocele. Cystourethrocele is a condition that occurs when both the bladder and urethra prolapse. Urine leakage during sneezing, coughing, exercise, etc., is a common symptom.
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Enterocele - When the front and back walls of the vagina weaken, the intestine will push against the vaginal skin. This can occur after a hysterectomy.
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Rectocele - When the back wall of the vagina weakens, the rectal wall presses against the vaginal wall, which creates a bulge. During bowel movements, this bulge may become prominent.
What Is the Cause of Vaginal Prolapse?
A network of muscles and other tissues provides the primary support for the pelvis, vagina, and surrounding organs. Levator ani is located below most pelvic organs and pelvic ligaments and supports the organs' weight. When parts of this support network damage or weaken, the vagina and surrounding structures lose the support that holds them in place. When this happens, the vagina may slip down from the place, causing a prolapse.
The common causes of vaginal prolapse can include:
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Childbirth - Vaginal delivery can damage the muscles, tissues, and ligaments surrounding the vagina. Long, complicated labor and large babies can damage these structures.
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Hysterectomy - The uterus is an essential support structure to the upper part of the vagina. During a hysterectomy, the uterus is removed, leading to the fall of the top of the vagina toward the vaginal opening, called a vaginal vault prolapse. Hysterectomy can also cause an enterocele.
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Menopause - During menopause, ovaries stop producing hormones that regulate the menstrual cycle. Estrogen is a hormone making the pelvic muscles strong. When your body does not have much estrogen, the pelvic muscles can weaken, and prolapse can develop.
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Other Risk Factors - Vaginal Prolapse can also occur due to obesity, connective tissue abnormalities, advanced age, dysfunction of the nerves and tissues, prior pelvic surgery, and strenuous physical activity.
What Are the Symptoms of Vaginal Prolapse?
Depending on the type of vaginal prolapse, the symptoms may vary. However, the typical sign of all kinds of vaginal prolapse is the sensation that something is stuck in the vagina or that structures in the vagina are out of place. These feelings often get adverse as the day goes on or after lifting, standing, or coughing. This may be due to the protrusion or pressure in the area.
Generally, the more advanced the prolapse, the more severe the symptoms.
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Changes in bowel function, such as difficulty in emptying the bowel.
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Changes in bladder function, such as the inability to empty the bladder.
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Pain or discomfort during sexual intercourse
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Difficulty using tampons
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Lower back pain.
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Bulging in the vagina.
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Urinary incontinence (leakage of urine).
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Bladder infections.
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Problems with sexual intercourse.
How Is Vaginal Prolapse Diagnosed?
A physical exam diagnoses vaginal prolapse, and the doctor enquires about the history and symptoms of the patient's experience, family history, and previous pregnancies. In some cases, the patient might not show any signs, but the prolapse could be found during a routine examination.
The following test helps doctors to evaluate vaginal prolapse:
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Bladder Function Test - This test helps find the bladder's ability to store and empty the bladder. The pressures of the urethra and bladder are also measured.
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Q-Tip Test - In this test, the doctor inserts a small cotton-bud applicator coated with an anesthetic gel into the urethra of the patient. The doctor then instructs the patient to strain down. If there are 30 degrees or more raises of the applicator, the urethra descends while straining. It is a predictive factor of the success of anti-incontinence surgery.
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Imaging Tests
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Magnetic Resonance Imaging (MRI) -This imaging tool produces a three-dimensional image of the pelvis on the computer screen using these signals.
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Ultrasound - This diagnostic tool uses sound waves to visualize the bladder or kidneys in patients with urinary incontinence or the muscles around the rectum in women with fecal incontinence.
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Cystourethroscopy - A cystoscope is a small, tube-like instrument with a light and camera; it allows for visualization of the interior of the urethra and bladder on a television screen.
How to Treat Vaginal Prolapse?
Early treatment for vaginal prolapses is beneficial because, over time, vaginal prolapses will gradually worsen and can only be corrected with surgery. However, the type of treatment depends on the severity and cause of the prolapse, age, overall medical status, if any desire for future childbearing, and whether the patient is sexually active. Nonsurgical options may be most appropriate for women who are not sexually active, cannot undergo surgery for medical reasons, or experience few or no symptoms associated with the condition.
Nonsurgical Treatments at Home for Vaginal Prolapse -
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Activity Modification - Vaginal prolapse with minor or no symptoms; the doctors recommend activity modification such as straining or avoiding heavy lifting.
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Pessary - It is a small device made of rubber or soft plastic. It is placed inside the vagina for support. This option may be appropriate for women who are not sexually active, and surgical procedures are not possible because of advanced age or medical conditions. This device should be removed and cleaned regularly to prevent infection or erosion of the vaginal walls.
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Kegel Exercises - Kegel exercises help treat mild-to-moderate cases of vaginal prolapse. These exercises tighten the muscles of the pelvic floor.
Surgical Procedures -
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Vaginal vault suspension - During this procedure, the vagina is attached to the ligaments inside the pelvis, which hold the vagina in place.
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Sacrocolpopexy - A piece of mesh is attached to the vagina and secured with the tailbone, which provides a lift to the vagina.
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Colpocliesis - During this surgery, narrowing, shortening, or closure of the vagina is done to support the pelvic organs. However, after this procedure, penetrative sex is impossible. A colpocleisis is recommended to be done in older women with prolapse.
Conclusion
Vaginal prolapse happens due to the weakening of pelvic floor muscles. Lifestyle changes and the correct treatment plan will be beneficial. Consult a doctor before symptoms worsen; they can help develop good lifestyle habits and a treatment plan.
