What is a vaginal prolapse?
A vaginal prolapse is a dropping of your vagina from its normal location in the body. The vagina, also called the birth canal, is the tunnel that connects the uterus to the outside of a woman’s body. Your vagina is one of several organs that rests in the pelvic area of your body. These organs are held in place by muscles and other tissue. These muscles come together to create a support structure. Throughout your life, this support structure can start to weaken. This can happen for a variety of reasons, but the result is a sagging of your organs. When your organs sag or droop out of their normal position, this is called a prolapse.
Prolapses can be small—with just a little movement—or large. A small prolapse is called an incomplete prolapse. A bigger prolapse (called a complete prolapse) is one where the organ has shifted significantly out of its normal place. A complete prolapse can result in part of the organ sticking out of the body. This is a very severe prolapse.
Are there different types of prolapse?
There are several different types of prolapse. Several of the organs in your pelvic area can shift out of place, developing into a prolapse. The different types of pelvic organ prolapse can include:
- Vaginal vault prolapse: The top of the vagina (known as the “vaginal vault”) droops down into the vaginal canal. This usually occurs in women who have had a hysterectomy (removal of the uterus).
- Uterine prolapse: The uterus bulges or slips into the vagina, sometimes so far that it comes out of the vaginal opening.
- Cystocele: The bladder drops into the vagina.
- Urethrocele: The urethra (the tube that carries urine away from the bladder) bulges into the vagina. A cystocele and urethrocele are often found together.
- Rectocele: The rectum bulges into or out of the vagina.
- Enterocele: The small intestine bulges against the back wall of the vagina. An enterocele and vaginal vault prolapse often occur together.
How common is vaginal prolapse?
Vaginal prolapse is fairly common. More than one-third of women in the U.S. have some type of pelvic area prolapse during their lifetime. You’re more likely to experience a vaginal prolapse later in life, especially if you have had multiple pregnancies with a vaginal birth.
Symptoms and Causes
What causes vaginal prolapse?
Your vagina is held in place within your pelvis by a group of muscles and other tissue—creating a support structure of sorts. This structure keeps the organs in your pelvis in place. Over time, this structure can weaken. When that happens, the vagina might slip down out of place, causing a prolapse. Several common causes of a vaginal prolapse can include:
- Childbirth: Vaginal delivery raises the risk of prolapse more than a cesarean section (when the baby is delivered through a surgical opening in the wall of the abdomen). It’s also thought that the more children a woman delivers, as well as the delivery of a large baby (more than 9 pounds), will raise the risk of prolapse.
- Surgery: A procedure like a hysterectomy, or radiation treatment in the pelvic area, could cause a prolapse.
- Menopause: During menopause, your ovaries stop producing hormones that regulate your monthly menstrual cycle (period). The hormone estrogen is particularly important because it helps keep your pelvic muscles strong. When your body doesn’t make as much estrogen as before, those pelvic muscles can become weak and a prolapse can develop.
- Aging: As you grow older, you are at a higher risk of forming a prolapse.
- Extreme physical activity or lifting of heavy objects: Strain from activity can also weaken your pelvic muscles and allow your organs to sag out of position.
- Genetic or hereditary factors: Your pelvic support system could naturally be weaker than typical. This can be passed down throughout your family.
Activities or conditions that place extra pressure on your abdominal area can also cause a prolapse. These can include:
- Being overweight.
- Straining to have a bowel movement.
- Having a chronic cough (such as in smokers or people with asthma).
What are the symptoms of vaginal prolapse?
In many cases, you may not feel any symptoms from a prolapse. You may find out about a vaginal prolapse during an exam in your healthcare provider’s office. If you do experience symptoms, they can include:
- A feeling of fullness, heaviness or pain in the pelvic area. This feeling often gets worse as the day goes on or after standing, lifting or coughing.
- Lower back pain.
- Bulging in the vagina.
- Organs slipping out of the vagina.
- Leakage of urine (urinary incontinence).
- Bladder infections.
- Difficulty having a bowel movement.
- Problems with sexual intercourse.
- Problems inserting tampons.
Diagnosis and Tests
How is vaginal prolapse diagnosed?
A vaginal prolapse is often diagnosed in your healthcare provider’s office during an appointment. Your provider will do a physical exam, talk to you about any symptoms of fullness in your pelvic area or urinary incontinence (leakage). You may also be asked about your family history and about any previous pregnancies.
In some cases, you may not have any symptoms and the prolapse could be found during a routine exam with your healthcare provider.
Management and Treatment
How is vaginal prolapse treated?
Treatment for vaginal prolapse can vary depending on the severity of your prolapse. In some cases, your healthcare provider may want to just watch it over time to make sure it doesn’t get worse.
There are non-surgical and surgical treatment options for vaginal prolapses. These treatments are very similar to treatment options for uterine prolapses. There are a few things your healthcare provider will take into account when forming a treatment plan. These can include:
- Your general health and if you have any other serious medical conditions.
- Your age.
- The severity of your prolapse.
- If you want to have children in the future.
- If you want to have penetrative sex in the future.
It’s important to have an open and honest conversation with your healthcare provider about these topics. Some of the treatment options can mean no longer being able to become pregnant or have intercourse. Talk to your healthcare provider about any questions or concerns you have regarding these treatments.
Non-surgical treatments are typically used as a first option and work best with very minimal prolapses. Specific non-surgical treatment options can include:
- Exercise: The muscles of your pelvis can be strengthened with exercises called Kegel exercises. To do these exercises, tighten your pelvic muscles as if you are trying to hold back urine. Hold the muscles tight for a few seconds and then release. Repeat this 10 times. You can do this up to four times a day and these exercises can be done anywhere.
- Vaginal pessary: Typically shaped like a small plastic or rubber doughnut, a pessary is a device that’s inserted into your vagina. It acts as a support structure, helping to hold things in place. A pessary is fitted and inserted by your healthcare provider. You will need to clean it frequently and remove it before having sex.
- For more severe cases, surgery can be a treatment option. These options include:
- Vaginal vault suspension: This procedure involves attaching the vagina to the ligaments inside the pelvis that used to hold it up. The surgery is done through a cut (incision) in the vagina.
- Sacrocolpopexy: This procedure involves attaching a piece of mesh to your vagina and securing the mesh to your tailbone to give the vagina a lift. This surgery is done through your abdomen, using small incisions and minimally invasive surgery called laparoscopy.
- Colpocliesis: This procedure involves stitching the vagina shut. An advantage of this surgery is the outcome—your risk of getting another prolapse is low. However, once this procedure is done, you can no longer have penetrative sex. A colpocliesis is more likely to be done in older women with prolapse.
Can vaginal prolapse be prevented?
Often, you can’t prevent a vaginal prolapse. There are good lifestyle habits you can adopt to decrease your risk of developing a vaginal prolapse. These can include:
- Exercising regularly (Kegel exercises).
- Maintaining a healthy weight and diet.
- Not smoking.
- Using proper lifting techniques.
What are proper lifting techniques and how do they help prevent a prolapse?
When you lift something heavy, you can strain. This strain can lead to a prolapse. By following a few tips, you can lower your risk of prolapse.
- Don’t lift alone: When you have something that’s oddly shaped or very large, get help lifting it. Also, avoid lifting something above waist level.
- Check your footing: Make sure you have a good footing before lifting something.
- Lift with your legs: When you pick something up that’s lower than the level of your waist, keep your back straight and bend at your knees and hips. Do not bend forward at the waist with your knees straight.
- Use a wide stance: Keep your feet apart and firming on the ground when you lift something.
- Don’t jerk or twist when you lift something: Make sure that you straighten your knees in a steady motion and don’t jerk the object up to your body.
- Reposition objects before lifting: If you’re lifting an object from a table, slide it to the edge so that you can hold it close to your body.
- Hold packages close to your body: Keep your arms bent, your stomach muscles tight and hold the object closer to the core of your body.
- Take small steps: Don’t rush when moving with a package. Take your time and use small steps.
- Lower objects in the same way you picked them up: Place your feet apart, tighten your stomach muscles and bend at your hips and knees to lower an object.
Outlook / Prognosis
Can a vaginal prolapse happen again?
A vaginal prolapse can happen again after treatment. However, most treatment plans are very successful. If you have multiple prolapses or a severe prolapse, your healthcare provider may talk to you about surgical treatment options.
What’s the outlook for a vaginal prolapse?
In most cases, the outlook for a vaginal prolapse is positive. Treatment and lifestyle changes typically work well. Talk to your healthcare provider about all treatment options and what each option would mean for you. Your provider can help you develop good lifestyle habits that might help lower your risk of developing a vaginal prolapse in the future.