Vaginal Prolapse

Childbirth (especially multiple births) is stressful to the tissues in and around the vagina. Long, difficult labours and large babies are especially stressful to these structures. Childbirth is the risk factor most commonly associated with cystoceles, in which the bladder prolapses through the anterior vaginal wall.

Because oestrogen is a hormone that helps to keep the muscles and tissues of the pelvic support structure strong, menopause – the natural cessation of a woman’s oestrogen production – is also an important cause of vaginal prolapse.

The uterus is an important part of the support structure at the top of the vagina. A hysterectomy involves removing the uterus. Without the uterus, the top of the vagina may gradually fall toward the vaginal opening. This condition is called a vaginal vault prolapse. As the top of the vagina droops, added stress is placed on other ligaments. Hysterectomy is also commonly associated with an enterocele, in which the small bowel herniates near the top of the vagina.

The symptoms associated with a vaginal prolapse depend on the type of prolapse present. The most common symptom of all types of vaginal prolapse is the sensation that tissues or structures in the vagina are out of place.

Some women describe the feeling as “something coming down” or as a dragging sensation. This may involve a protrusion or pressure in the area of the sensation. Generally, the more advanced the prolapse, the more severe the symptoms. Some general symptoms common to all types of vaginal prolapse include pressure felt in the vagina or pelvis which may alleviate while laying down, painful intercourse, a lump seen at the vaginal opening and recurrent urinary tract infections.

Diagnosis of any type of vaginal prolapse involves a medical history and physical examination of the woman. This involves the gynaecologist examining each section of the vagina separately to determine the type and extent of the prolapse and what type of treatment is most appropriate. Additional tests such as urodynamics study and MRI of pelvis may be required for diagnostic purposes.

Nonsurgical options may be most appropriate for women who are not sexually active, cannot undergo surgery because of medical reasons, or experience few or no symptoms associated with the condition. Treatments include one or a combination of activity modification, pessary (a small device placed within the vagina for support), oestrogen cream, electrical stimulation within the vagina or on the pelvic floor, and biofeedback (a sensor used to monitor muscle activity in the vagina and on the pelvic floor).

Surgical intervention is aimed at correcting all weaknesses at once via the vaginal route and is usually performed under general anaesthesia. Women who undergo surgery for vaginal prolapse repair should normally expect to spend 1-2 days in the hospital depending on the type and extent of surgery involved. After surgery, women are usually advised to avoid heavy lifting for approximately 6-9 weeks. Vaginal prolapse surgery results are usually good, with a low recurrence rate.

Although embarrassing and debilitating, vaginal prolapse can be prevented. Women at risk for vaginal prolapse should avoid putting extra strain to their pelvic muscles such as heavy lifting, chronic constipation, chronic cough and standing for long periods, if possible. Obesity also puts extra stress on the muscles and ligaments within the pelvis and vagina. Weight control may help prevent this condition from developing.

Dr Michael Wong

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