193065 Health Library | Health and Wellness | Wellmont Health System
  • Vaginal Prolapse

    (Pelvic Floor Relaxation)

    Definition

    Vaginal prolapse is the inward and downward bulging of the vaginal walls. It occurs when the supporting tissues of the lower pelvis weaken. The lack of support causes the walls of the vagina to weaken, sag, and collapse. Prolapse may also occur after hysterectomy . Other structures or organs near the vagina are also shifted. Types of vaginal prolapse include:
    • Cystocele (dropped bladder)—when the collapse involves the front of the vagina and bladder
    • Rectocele —when the collapse involves the back of the vagina and rectum
    • Enterocele—when the collapse involves the top vaginal wall and small bowel
    The severity of vaginal prolapse may be defined as:
    • First degree—collapse into the upper part of the vagina
    • Second degree—collapse further into the vaginal canal, down to the level of the vaginal opening
    • Third degree—collapse that extends beyond the opening

    Causes

    Vaginal prolapse is caused by weakened support structures in the pelvic region.
    Pelvic Floor Muscles and Organs
    Pelvic floor muscels
    Copyright © Nucleus Medical Media, Inc.

    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, sneezing, coughing, or exercising
    • Difficulty with bowel movements
    • Difficult or painful intercourse

    Diagnosis

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

    Kegel Exercises

    Kegel exercises involve tensing the muscles around the vagina and anus, holding for several seconds, then releasing. The repetition of this exercise will help to tone pelvic muscles.

    Pessary Insertion

    Your doctor may insert a pessary into the upper portion of the vagina. A pessary is a rubbery, doughnut-shaped device. It helps to prop up the uterus and bladder. Pessary placement is more often used in older women.

    Surgery

    Vaginal prolapse that is severe or associated with lasting symptoms may require surgery. Surgery may involve repairing the pelvic floor structure or, in some cases, to suture the vagina.
    If you are diagnosed with vaginal prolapse, follow your doctor's instructions .

    Prevention

    To help prevent vaginal prolapse:
    • Do Kegel exercises .
    • 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.

    RESOURCES

    American Congress of Obstetricians and Gynecologists http://www.acog.org/

    Women's Health.gov http://www.womenshealth.gov/

    CANADIAN RESOURCES

    Canadian Women's Health Network http://www.cwhn.ca/indexeng.html/

    Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/

    References

    Pelvic organ prolapse. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated July 31, 2012. Accessed August 14, 2012.

    Pelvic organ prolapse. International Urogynecological Association website. Available at: http://www.iuga.org/resource/resmgr/Brochures/eng%5Fpop.pdf . Published 2011. Accessed August 14, 2012.

    Uterine and vaginal prolapse. Merck website. Available at: http://www.merck.com/mmpe/sec18/ch250/ch250c.html . Updated 2008. Accessed August 14, 2012.

    5/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Fritel X, Varnoux N, Zins M, Breart G, Ringa V. Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors. Obstet Gynecol. 2009;113:609-616.

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