In vaginal prolapse the vagina stretches or expands to protrude on other organs and structures. Cleveland Clinic urologists are developing new minimally invasive laparoscopic surgical techniques to repair these conditions, which can greatly affect the quality of life for the patient.
What is Vaginal Prolapse?
In vaginal prolapse the vagina stretches or expands to protrude on other organs and structures. The situation seldom involves the vagina alone. Supports for the uterus often stretch allowing it to also fall (prolapse) when a woman strains during a bowel movement.
- When the protrusion involves the front (anterior) of the vagina and bladder, the presentation is called a cystocele or dropped bladder
- When the back (posterior) of the vagina and rectum are involved, the presentation is called are rectocele
- When the anterior vaginal wall and small bowel are involved the situation is called an enterocele
This shows the bladder which has herniated, or “dropped” into the vagina.
This shows the rectum which has been herniated into the vagina.
This shows the uterus, which has dropped out of the opening to the vagina. If the uterus has been removed, the top of the vagina can also drop down. This would be called apical prolapse.
Many women do not have any symptoms. Those that have symptoms may note a fullness or discomfort in the vagina, a sensation of heaviness or pulling in the pelvis and/or low backache that is relieved when lying down.
Other symptoms may be urinary frequency and/or stress incontinence – passing urine when laughing, coughing or exercising. Difficulty with bowel movements is associated with rectocele. Intercourse may be difficult or painful in women with prolapse.
Vaginal childbirth, especially multiple births and aging are the primary risk factors. Prolonged labor and large children can stretch and weaken pelvic floor muscles leading to weakened support for the vagina. This does not happen in all women but does happen in many who may not recover completely from the birthing process. Menopause initiates a host of changes in a woman’s body, which can affect pelvic region muscle tone.
Aging in general weakens muscles throughout the body including the pelvic region. Other factors such as obesity and chronic coughing associated with asthma, smoking and respiratory disease are also associated with weakening these muscles. Chronic constipation and bearing down to expel waste can weaken pelvic muscles.
Women without symptoms are often diagnosed with the problem during routine gynecological examinations. Symptomatic women are also usually diagnosed by their gynecologist. The problem is apparent to these specialists who can diagnose it with a thorough medical history and physical exam. Laboratory testing or imaging studies are rarely needed.
As with most medical conditions, conservative approaches are employed first, primarily pelvic exercises designed to strengthen the muscles in the entire region. Women whose age or physical condition may prohibit exercise may be fitted with a pessary, a vinyl ring inserted in the vagina to hold the prolapse in place.
If conservative measures fail, surgery may be employed after thorough consultation with specialists. Subjects that may be discussed during consultation include the woman's age and general health, desire for future pregnancies, her wish to preserve vaginal function, the degree of prolapse and anatomic conditions that affect decisions as to which surgical procedure to pursue. For instance, a hysterectomy (removal of the uterus) may be required when significant prolapse is present.
There are two primary approaches depending on the condition. Many surgeries are conducted through the vagina, an approach that leaves no scars, while laparoscopy is an increasingly sought after method of repairing prolapse. These surgical procedures are conducted through narrow tubes inserted through incisions less than an inch long. These procedures have been shown to reduce scarring, blood loss, and hospital stays, and speed recovery times.
A surgical procedure called anterior colporrhaphy tightens the front walls of the vagina, while posterior colporrhaphy tightens the back walls. Laparoscopic procedures are employed to relieve stress incontinence, repair hernias at the top of the vagina, and to create support for vagina’s that have become weakened by a hysterectomy. In instances in which supporting tissues have been weakened, additional natural tissue or artificial materials (mesh) may be placed to support the repair.
Hospitalization is brief, usually a day, sometimes two and seldom more than four. Patients are released with prescriptions for pain killers and antibiotics to prevent infection.
Additional Treatment Information
Further information on our therapy options and surgical procedures are available in our latest guide publication.