Definition
Vaginal prolapse is the inward and downward bulging of the vaginal walls. 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. The lack of support causes the walls of the vagina to weaken, sag, and collapse.
| Pelvic Floor Muscles and Organs |
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Risk Factors
Your risk of vaginal prolapse increases with age. Other factors include:
- Multiple vaginal deliveries
- Post- menopause
- Obesity
- Straining caused by chronic cough , constipation , or heavy lifting
- Family history
Symptoms
Symptoms may include:
- Pelvic pressure
- A feeling of vaginal fullness or heaviness
- A feeling of pulling in the pelvis
- Vaginal discomfort
- Urinary urgency and frequency
- Urination when laughing, sneezing, coughing, or exercising
- Constipation
- Difficult or painful intercourse
- Low backache that is relieved with lying down
Diagnosis
You will be asked about your symptoms and medical history. A physical exam will be done. Vaginal prolapse that has no symptoms may be diagnosed during routine examinations. You may be referred 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. You may be asked to do this up to 100 times a day.
Medications
Estrogen therapy may be advised. This may help prevent further weakness of the pelvic floor. Talk to your doctor about the risks and benefits associated with hormone replacement therapy.
Pessary Insertion
A pessary may be inserted 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, suturing the vagina.
Prevention
To help reduce your chances of vaginal prolapse:
- Do Kegel exercises.
- Maintain a healthy weight.
- To avoid constipation, eat plenty of fruits, vegetables, and whole grains. Drink plenty of fluids throughout the day.
- If you smoke, talk to your doctor about ways to quit . Smoking may cause chronic coughing and weakening of connective tissues.
- Limit heavy lifting.
RESOURCES
Office on Women's Health https://www.womenshealth.gov
The American Congress of Obstetricians and Gynecologists https://www.acog.org
CANADIAN RESOURCES
Canadian Women's Health Network http://www.cwhn.ca
Society of Obstetricians and Gynaecologists of Canada https://sogc.org
References
Pelvic organ prolapse. EBSCO DynaMed website. Available at: https://www.dynamed.com/topics/dmp~AN~T114467/Pelvic-organ-prolapse . Updated March 23, 2015. Accessed April 17, 2018.
Pelvic organ prolapse. International Urogynecological Association website. Available at: http://c.ymcdn.com/sites/www.iuga.org/resource/resmgr/Brochures/eng%5Fpop.pdf. Accessed April 17, 2018.
Uterine and vaginal prolapse. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-relaxation-syndromes/uterine-and-vaginal-prolapse. Updated February 2017. Accessed April 17, 2018.
Vaginal pessary. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/vaginal-pessary. Updated October 24, 2017. Accessed April 17, 2018.
10/21/2008 DynaMed's Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T116186/Constipation-in-adults : Shariati A, Maceda JS, Hale DS. High-fiber diet for treatment of constipation in women with pelvic floor disorders. Obstet Gynecol. 2008;111(4):908-913.
5/11/2009 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T114467/Pelvic-organ-prolapse : 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(3):609-616.
Revision Information
- Reviewer: EBSCO Medical Review Board Marcie L. Sidman, MD
- Review Date: 03/2018
- Update Date: 04/17/2018