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Vaginal Prolapse

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 this condition.

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 image shows what a normal female pelvis looks like

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.

What Causes Vaginal 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.

What Are the Symptoms of Vaginal 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.

How is Vaginal Prolapse Diagnosed?

Women without symptoms are often diagnosed with the problem during routine gynecological examinations. Symptomatic women are also usually diagnosed by their gynecologist. Physicians who specialize in gynecology can typically diagnose it with a thorough medical history and physical exam. Laboratory testing or imaging studies are rarely needed.

These physical examinations include a bladder function test and a pelvic floor strength test.

Pelvic floor strength test: During the pelvic examination, the doctor tests the strength of the pelvic floor, the sphincter muscles, and muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. Irregularities in this test can help diagnose vaginal prolapse and determine if kegel exercises would be helpful to the patient.

Bladder function test: Otherwise known as urodynamics, bladder function tests determine the ability of the bladder to store and eliminate urine. This is measured two ways. Uroflowmetry measures the volume and force of the urine stream. Cystometrogram is a procedure which fills the bladder with water via catheter. Measurements of volume are noted when the patient indicates urgency of urination.

How is Vaginal Prolapse Treated?

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.

Surgical Treatment Options

Raymond Rackley, MD discusses laparoscopic techniques in female urology.

If conservative measures fail, your physician may recommend surgery to help fix vaginal prolapse. When you meet with your surgery specialist, you may discuss your age and general health, desire for future pregnancies, 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.

Is Vaginal Prolapse Preventable?

Pelvic Organ Prolapse & Incontinence Treatment Guide

Learn more about Pelvic Organ Prolapse and Incontinence and how it can affect you.
Download the Treatment Guide

In most cases vaginal prolapse is unpreventable. However, if you address risk factors before they become problematic, it can help your vaginal health.

  • Perform Kegel exercises on a regular basis. These exercises can strengthen your pelvic floor muscles — especially important after you have a baby.
  • Treat and prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grain cereals.
  • Avoid heavy lifting and lift correctly. When lifting, use your legs instead of your waist or back.
  • Control coughing. Get treatment for a chronic cough or bronchitis, and don't smoke.
  • Avoid weight gain. Talk with your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them.

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