Mature Prolapse

Mature Prolapse

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Vaginal prolapse is a condition where your vagina slips out of position. It happens when the tissues and muscles in your pelvis weaken and overstretch. It’s more common in people who have had multiple vaginal deliveries during childbirth and have gone through menopause.

The American College of Obstetricians and Gynecologists. Pelvic Support Problems. (https://www.acog.org/womens-health/faqs/pelvic-support-problems) Accessed 9/15/2022.
InformedHealth.org [Internet]. Pelvic organ prolapse: Overview. (https://www.ncbi.nlm.nih.gov/books/NBK525783/) 2018 Aug 23. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Accessed 9/15/2022.
Kuncharapu I, Majeroni B, Johnson D. Pelvic Organ Prolapse. (https://www.aafp.org/afp/2010/0501/p1111.html) American Family Physician . May 2010; 81(9): 1111-1117. Accessed 9/15/2022.
Merck Manual Professional Version. Uterine and Apical Prolapse. (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-organ-prolapse-pop/uterine-and-apical-prolapse) Accessed 9/15/2022.
The Women’s, The Royal Women’s Hospital Victoria Australia. Vaginal Prolapse. (https://www.thewomens.org.au/health-information/vaginal-prolapse) Accessed 9/15/2022.
Women’s Health Concern. Prolapse: Uterine and vaginal. (https://www.womens-health-concern.org/help-and-advice/factsheets/prolapse-uterine-vaginal/) Accessed 9/15/2022.

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Vaginal prolapse (also called a vaginal vault prolapse) is when the top of your vagina falls from its normal location in your body. Your vagina, also called your birth canal, is the tunnel that connects your uterus to the opening of your vagina. When the top of your vagina becomes weak, the organs that they should be supporting collapse into your vagina, creating the sensation of a lump or bulge.
Your vagina is one of several organs that rests in the pelvic area of your body. These organs are held in place by muscles and other tissue. These muscles come together to create a support structure called your pelvic floor . Throughout your life, this support structure can start to weaken. This can happen for a variety of reasons, but the result is a sagging of your organs. When your organs sag or droop out of their normal position, this is called a prolapse. Vaginal prolapse is when the top of your vagina weakens and falls into your vaginal canal.
Prolapses can be small or large. A small prolapse is called an incomplete prolapse. A bigger prolapse (a complete prolapse) happens when your organ has shifted significantly. A complete prolapse can cause your organs to come out of your vaginal opening. This is a very severe prolapse.
Vaginal prolapse can cause painful symptoms. Mild to moderate vaginal prolapse may not require surgery. However, more severe cases may need surgical repair.
Your pelvis is comprised of your uterus, vagina, rectum, bladder and urethra. These organs are held up by your pelvic floor muscles, which look like an upside-down umbrella. The umbrella holds your pelvic organs up, but over time or due to other factors like vaginal deliveries, this upside-down umbrella can begin to collapse.
There are several different types of prolapse that have different names depending on where the organ has dropped from. The different types of pelvic organ prolapse can include:

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Vaginal prolapse is fairly common. More than one-third of women or people assigned female at birth (AFAB) have some type of pelvic area prolapse during their lifetime. You’re more likely to experience vaginal prolapse later in life, especially if you’ve had multiple pregnancies with a vaginal birth.
You may not know you have a prolapsed vagina until vaginal tissue from your vaginal wall protrudes from your vaginal opening. Some people have symptoms like pain or feeling like they are sitting on a ball. Others find out about a prolapsed vagina during a routine pelvic exam.
Several other pelvic organs can slip out of position, not just your vagina. Depending on the type of prolapse you have and its severity, other nearby organs may be affected. For example, you may have problems with your kidneys, urethra (the hole you pee from) and rectum (the hole you poop from). Because a prolapse can cause other problems, it’s important to get it checked out by your healthcare provider.
Symptoms of vaginal prolapse can include:
Some people don’t feel a prolapsed vagina because the prolapse is mild. Your healthcare provider may discover a mild prolapse during a routine gynecological exam. In other cases, you may feel like a ball is hanging from your vagina or experience pain when peeing or when having sexual intercourse.
Your vagina is held in place within your pelvis by a group of muscles and other tissue — creating a support structure, of sorts. This structure keeps your organs in your pelvis in place. Over time, this structure can weaken. When that happens, your vagina might slip down out of place, causing a prolapse. Several common causes of vaginal prolapse can include:
Activities or conditions that place extra pressure on your abdominal area can also cause a prolapse. These can include:
A gynecologist usually diagnoses vaginal prolapse during an appointment. They will do a physical exam and talk to you about any symptoms of fullness in your pelvic area or urinary incontinence (leaking pee). You may also be asked about any previous pregnancies and deliveries. In most cases, your provider can feel a prolapse by inserting a gloved finger in your vagina or upon a visual inspection of the area.
In some cases, you may not have any symptoms and your provider discovers a prolapse during a pelvic exam.
If you have problems peeing, your provider may order tests to check your bladder function. They may also order an MRI (magnetic resonance imaging) or pelvic ultrasound if they need a better view of all the other pelvic organs.
A prolapsed vagina is more likely to happen after menopause and after multiple vaginal childbirths. This is more likely to occur if you’re older than 50, but it can happen at any age.
Vaginal prolapse treatment can vary depending on the severity of your prolapse. In some cases, your healthcare provider may want to just watch it over time to make sure it doesn’t get worse.
There are nonsurgical and surgical treatment options for vaginal prolapses. There are a few things your healthcare provider will take into account when forming a treatment plan. These can include:
It’s important to have an open and honest conversation with your healthcare provider about these topics. Talk to your healthcare provider about any questions or concerns you have regarding these treatments.
Nonsurgical treatments are typically used as a first option and work best with minimal or mild prolapses. Specific treatment options can include:
For more severe cases, surgery to correct vaginal prolapse can be an option. These options include:
Not treating vaginal prolapse can cause the condition to worsen. In addition to more pain, you may also get sores on your vagina, infection and increase your risk for injury to other pelvic organs.
No, you can’t push a prolapsed vagina back up. Your healthcare provider is the only person who should treat a prolapsed vagina. You may be able to feel a prolapse, and you may need to push the prolapse back up to poop or pee, but pushing the prolapse back up is temporary and will not permanently fix the prolapse.
You can’t always prevent vaginal prolapse. There are good lifestyle habits you can adopt to decrease your risk of developing vaginal prolapse. These can include:
When you lift something heavy, you can strain your muscles. This strain can lead to a pelvic organ prolapse. By following a few tips, you can lower your risk of prolapse.
Vaginal prolapse can happen again after treatment. However, most treatment plans are very successful. If you have multiple prolapses or a severe prolapse, your healthcare provider may talk to you about surgical treatment options.
In most cases, the outlook for vaginal prolapse is positive. Treatment and lifestyle changes typically work well. Talk to your healthcare provider about all treatment options and what each option would mean for you. Your provider can help you develop good lifestyle habits that might help lower your risk of developing vaginal prolapse in the future.
Contact your healthcare provider if you have symptoms of prolapse like:
Don’t let symptoms of vaginal prolapse interfere with your daily life. See your healthcare provider if you have symptoms of vaginal prolapse like a bulging from your vagina or a feeling of fullness in your pelvis. Prolapse isn’t a serious condition, but it can cause problems if it’s left untreated or worsens. Mild cases of a prolapsed vagina can be fixed with Kegel exercises or a vaginal pessary. Surgery is needed in more severe cases.
Last reviewed by a Cleveland Clinic medical professional on 09/15/2022.

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LEXINGTON, Ky. (June 24, 2014) -- It's a problem many women are embarrassed to discuss, but pelvic organ prolapse is a very common disorder, especially among older women. Roughly half of women who have had children will experience a form of prolapse later in life, and more than one out of every 10 women will have at least one surgery to treat pelvic organ prolapse or urinary incontinence by the age of 80.
Pelvic organ prolapse occurs when the pelvic floor becomes weak or damaged and one or more pelvic structures drop from their natural positions into or even outside of the vaginal canal. Several structures can be involved, including the uterus, bladder, small bowel, rectum or the vagina itself.
Prolapse is caused by damage to the tissues that support the pelvic organs. This damage is often a result of several factors, with the most common cause being the trauma of childbirth. Other risk factors include obesity, chronic constipation, lung diseases that result in a chronic cough, prior hysterectomy (removal of the uterus), menopause, and heavy manual labor.
The symptoms of pelvic organ prolapse include a bulge or pressure in the vagina, a pulling or stretching feeling in the vagina or pelvis, discomfort with sexual intercourse, delayed or slow urine stream, difficulty with bowel movements, and urinary and fecal urgency or incontinence.
What's the best way to treat prolapse?
Treatment depends on several factors including the age and overall health of the patient, the severity of symptoms, the stage of the prolapse, the patient’s anatomy and prior surgical history and most importantly the patient’s preference.
For women with a mild case of prolapse, physicians may not recommend a surgical intervention. However, they may recommend nonsurgical treatments that can help prevent the prolapse from becoming worse, such as losing weight, quitting smoking, and avoiding lifting heavy objects.
For more severe prolapse, some women may choose to use a pessary (a medical device that provides internal support) while others may choose to undergo surgery.
Surgery can be laparoscopic with the assistance of the da Vinci robot or approached through the vagina. Women often have other pelvic floor disorders in addition to prolapse including overactive bladder (urinary frequency, urgency and urge incontinence) or stress urinary incontinence (leakage of urine with coughing, laughing, or exercise) that need to be addressed at the same time.
For younger women, the potential loss of childbearing ability plays a role in the patient's treatment. Treatment should be individualized for each patient and it is important to see a physician that specializes in the treatment of pelvic floor disorders, such a surgeon board-certified in Female Pelvic Medicine Reconstructive Surgery.
Why should women seek treatment sooner rather than later?
The symptoms of pelvic organ prolapse can worsen over time. The sooner a woman seeks treatment the sooner we can work on alleviating the symptoms and improving her quality of life.
Dr. Katie Ballert specializes in female pelvic medicine and reconstructive surgery at UK HealthCare.
This column appeared in the June 22, 2014, edition of the Lexington Herald-Leader

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Change your activities to prevent stress to the vaginal walls. [2]
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If you have only mild vaginal prolapse, your doctor will likely recommend modifying your activities to avoid heavy lifting and/or straining. This will reduce the stress on your pelvic floor muscles, and may help to improve (or at least to prevent worsening of) your vaginal prolapse.
Keep in mind that surgery is not necessary with vaginal prolapse. You can leave the prolapse untreated without any negative impact on your health.

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Consider trying a device meant to support the vaginal walls. [3]
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Something called a "vaginal pessary" is a circular device, usually made of soft plastic or rubber, that is inserted into your vagina. The pessary will hold your vaginal structures in place, thus preventing symptoms of prolapse and/or worsening of your prolapse. You will need to see your doctor to discuss this treatment option and to have it inserted into your vagina.

A vaginal pessary must be removed and cleaned at regular intervals.
Your physician can instruct you on how to do this, as well as the frequency at which it needs to be done.
Some women find vaginal pessaries uncomfortable, or find that they fall out and have difficulty keeping them in place.
Try a pessary and to see how you feel with it in. You can evaluate from there whether you find it a helpful mode of treatment.
Vaginal pessaries are more successful in women who are not sexually active than in women who are. If you are sexually active, you or your partner can remove the pessary for intercourse. [4]
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Perform Kegel exercises to strengthen your pelvic floor muscles. [5]
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Kegel exercises strengthen the pelvic floor muscles - these function to support the uterus and vagina, as well as the bladder, the small intestine, and the rectum. Do Kegel exercises at least 3 times per day, ultimately aiming for 10 repetitions each time. Here's how to effectively perform Kegel exercises:

To identify your pelvic muscles (the ones you will be flexing during Kegel exercises), stop urinating mid-stream. Notice which muscles you used to do this task - this feeling of muscle tightening is what you will be aiming for when
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