Definition

Vaginal prolapse occurs when the supporting tissues (walls) of the vagina weaken and protrude inward and downward (downward in the standing position). Other structures or organs that adjoin the vagina are also displaced, just behind the vaginal walls. Types of vaginal prolapse include:

  • Cystocele (dropped bladder)—when the protrusion involves the front of the vagina and bladder
  • Rectocele—when the protrusion involves the back of the vagina and rectum
  • Enterocele—when the protrusion involves the top vaginal wall and small bowel

The severity of vaginal prolapse may be simply defined as:

  • First degree—a protrusion into the upper part of the vagina
  • Second degree—protrusion further into the vaginal canal
  • Third degree—a protrusion that reaches the vaginal opening or extends beyond the opening

There are modern, more sophisticated ways of measuring and describing prolapses that specialist physicians use.

Causes

Vaginal prolapse is cause by weakened supportive structures—fascia (a fibrous tissue), ligaments, and muscles—in the pelvic region.

Risk Factors

The following factors increase your chance of developing vaginal prolapse:

Symptoms

Vaginal prolapse may not cause any symptoms. But when it does, the symptoms may include:

  • Vaginal pressure
  • A feeling of vaginal fullness or heaviness
  • A feeling of pulling in the pelvis
  • Discomfort in the vagina
  • Low backache that is relieved with lying down
  • Urinary frequency
  • Urination when laughing, coughing, or exercising
  • Difficulty with bowel movements
  • Painful intercourse

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Vaginal prolapse that has no symptoms may be diagnosed during routine gynecologic examinations. Your doctor may refer you to a gynecologist, who will perform a pelvic exam.

Treatment

Talk with your doctor about the best treatment plan for you. First- or second-degree prolapse without symptoms may not require treatment. Treatment options include:

Pessary Insertion

A pessary is a rubbery, doughnut-shaped device that is inserted by your doctor into the upper portion of the vagina. It helps to prop up the uterus and bladder.

Surgery

Vaginal prolapse that is severe or associated with persistent symptoms may require surgery. Surgery usually includes hysterectomy and colporrhaphy (surgical repair of the pelvic support structures), along with suturing the vagina to a stable structure in order to suspend it.

Prevention

To help prevent vaginal prolapse:

  • Do Kegel exercises regularly, especially before and after childbirth.
  • Avoid constipation.
  • Maintain a healthy weight.
  • If you smoke, quit . Smoking may cause chronic coughing and weakening of connective tissues.
  • Limit heavy lifting.
  • Avoid birth canal trauma at childbirth.