Vaginal Prolapse

Vaginal prolapse is when the top of your vagina (the apex) falls from its normal location. It’s a type of pelvic organ prolapse (POP).

Your vagina is one of several organs that rest in your pelvis. Muscles and other tissues hold these organs in place. These muscles come together to create a support structure called your pelvic floor.

When your pelvic floor muscles weaken, the top of your vagina can sag down lower in your vaginal canal. In severe cases, it can fold in on itself and stick out of your vaginal opening. If you have a uterus, it will likely also drop down.

This condition can cause many different symptoms. Mild to moderate vaginal prolapse may not require surgery. But more severe cases may need surgical repair.

Other names for vaginal prolapse are vaginal vault prolapse and apical prolapse.

Symptoms of vaginal prolapse

You may not know you have a prolapsed vagina until tissue sticks out of your vaginal opening. Some people have symptoms like pressure, fullness or feeling like they’re sitting on a ball. Others find out they have it during a routine pelvic exam.

Vaginal prolapse symptoms can include:

• A feeling of fullness, heaviness or pain in your pelvic area (this tends to get worse as the day goes on or after standing, lifting or coughing)
• Lower back pain
• Bulging in your vagina
• Feeling like something is slipping out of your vagina
• Leaking pee or feeling like you can’t completely empty your bladder
• Repeated urinary tract infections (UTIs)
• Difficulty pooping
• Difficulty with vaginal sex

Vaginal prolapse causes

Vaginal prolapse happens when the muscles, ligaments and tissues that support the top of your vagina weaken. These are your pelvic floor muscles. If they’re damaged or weakened to the point where they can’t provide support, the top of your vagina can sag down.

Factors that contribute to this prolapse include:

• Hysterectomy (surgery to remove your uterus)
• Vaginal childbirth, especially if you’ve had many babies or large babies (more than 9 pounds)
• Loss of muscle tone due to menopause
• Obesity
• Chronic coughing or straining
• Chronic constipation
• Repeated heavy lifting

Complications

Not treating vaginal prolapse can potentially cause the condition to worsen. In addition to feelings of increased pressure, you may also get sores on your vagina and increase your risk for injury to other pelvic organs.

Untreated vaginal prolapse can cause peeing and pooping issues, too. For example, it can lead to frequent UTIs or worsening constipation.

The condition can also take a toll on your mental health and sex life. This is why it’s important to get medical care.

How doctors diagnose vaginal prolapse

Your healthcare provider (usually a gynecologist) will ask about your symptoms. They’ll also do a pelvic exam. In most cases, your provider can see vaginal vault prolapse or feel it by inserting a gloved finger in your vagina.

If you have problems peeing, your provider may suggest tests to check your bladder function.

How is it treated?

Vaginal prolapse treatment can vary based on its severity. There are nonsurgical and surgical options. Your provider will consider certain factors when forming a treatment plan, like:

• Your general health
• Your age
• The prolapse severity
• Whether you want a pregnancy in the future
• Whether you want vaginal sex in the future

It’s important to have an open and honest conversation with your provider about these topics. Bring up any questions or concerns you have regarding treatments.

Nonsurgical treatments

Nonsurgical treatments are typically the first option and work best for mild prolapse. In some cases, your healthcare provider may want to just check on it over time to make sure it doesn’t get worse.

Specific treatment options can include:

• Pelvic floor physical therapy: Physical therapy exercises focus on strengthening your pelvic floor muscles. This may be the only treatment you need for mild cases.
• Vaginal pessary: A pessary is a silicone device that sits in your vagina. It acts as a support structure, helping to hold tissues in place. Your provider will decide the best size and style based on your physical activity level and prolapse severity.

Surgery

For more severe cases, surgery can help correct vaginal prolapse. Options include:

• Vaginal vault suspension: The surgeon attaches your vagina to ligaments inside your pelvis.
• Sacrocolpopexy: The surgeon attaches a piece of mesh to your vagina. They secure the mesh to your tailbone to give your vagina a lift.
• Colpocleisis: The surgeon creates a tissue bridge just inside your vaginal opening, which holds back the prolapse. An advantage of this surgery is that your risk of getting another prolapse is low. But once you have this procedure, you can’t have vaginal sex.

What can I expect if I have this condition?

Your outlook depends on several factors, like the prolapse severity and the treatment option you choose.

Most treatment plans are very successful. But vaginal prolapse can happen again. Stay in touch with your healthcare provider. Let them know if your symptoms change or get worse.

Can this be prevented?

You can’t always prevent vaginal prolapse. But some lifestyle tips that can reduce your risk include:

• Maintain a healthy weight and exercise regularly
• Do Kegel exercises to strengthen your pelvic floor muscles
• Manage coughing by getting treatment for medical conditions or quitting smoking
• Use proper lifting techniques when carrying heavy objects
• Manage constipation