Prolapse Vagina

Prolapse Vagina

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Nancy LeBrun is an Emmy and Peabody award-winning writer and producer who has been writing about health and wellness for more than six years
Peter Weiss, MD, is a board-certified OB/GYN and expert in women's health.

Vaginal prolapse, also known as vaginal hernia, is when the vagina slips out of place in the body. Sometimes the vagina moves only slightly or it can shift significantly. In the most severe cases, it can protrude from the body. Vaginal prolapse can cause discomfort but can be treated with vaginal physical therapy, medication, or surgery, if necessary.

This article discusses the signs, causes, and treatment of vaginal prolapse.

Many women do not have any symptoms of vaginal prolapse. Healthcare providers may discover it during a gynecological exam. Women who experience signs and symptoms may have: 1

In severe cases, an organ may protrude through the vaginal opening.

Vaginal prolapse is more common in women who:

There are two types of vaginal prolapse, categorized by how much the vagina has moved.

When the prolapse is small and the vagina has dropped only partway into the vaginal canal, it is called an incomplete prolapse. Larger prolapses are called complete prolapses, in which some vaginal tissue can protrude from the body.

Prolapses are also categorized by the affected organs: 2

As many as a third of all women will have some sort of vaginal prolapse at some point in their lives. 2 The most common causes are: 1

There are some other rare medical conditions, such as a tumor or a congenital bladder condition, that can cause prolapse.

Healthcare providers diagnose a vaginal prolapse from a physical examination. They may ask you to move muscles like you are having a bowel movement or as if you are stopping urination.

They will also ask about any symptoms, such as incontinence , that you may be experiencing.

If a complete prolapse is suspected, they may order an imaging test such as an ultrasound to see how the prolapse may be affecting or affected by other organs.

If the prolapse is minor and you are not having symptoms, you may not need treatment. If it is causing discomfort, treatment includes:

Vaginal prolapse is a condition in which the vagina slips down in the body. It's more common in women who have delivered several children vaginally, and in older, post-menopausal women. Vaginal prolapse may not cause any symptoms, but if it does, physical therapy and possibly surgery (if the prolapse is severe) can strengthen the pelvic muscles and help support the vagina.

Vaginal prolapse can cause discomfort. If you notice a feeling of heaviness or like you are sitting on something that bulges, you may have a prolapse. Contact your healthcare provider or gynecologist if you experience symptoms so you can get treated.

If you feel pressure, like you may be sitting on something that bulges, or feel heavy or full, you may have a prolapse. A healthcare provider can diagnose you and treat the prolapse if you need it.
Most prolapses don't need treatment or respond well to treatment. It's possible for a prolapse to recur after surgery, but it's unlikely.
Pelvic muscle exercises can help strengthen the muscles that support the vagina. Have a professional show you how to do them properly and how often.
If you have difficulty with bowel movements or urination, or if you notice tissue protruding from your vagina, you may have a severe prolapse, which typically responds well to treatment.
Johns Hopkins Medicine. Vaginal prolapse .
John Muir Health. Vaginal prolapse .

By Nancy LeBrun

In addition to her extensive health and wellness writing, Nancy has written about many general interest topics for publications as diverse as Newsweek, Teen Vogue, abcnews.com, and Craftsmanship Quarterly. She has authored a book about documentary filmmaking, a screenplay about a lost civil rights hero, and ghostwritten several memoirs.

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Medical Author:

George Lazarou, MD, FACOG

Medical Editor:

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What Are Common Causes of Vaginal Prolapse?

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What Are Different Types of Vaginal Prolapse?
Questions to Ask the Doctor About Prolapsed Vagina
When to Call a Doctor and Seek Medical Help for a Prolapsed Vagina
What Self-Care Measures Can Treat Vaginal Prolapse at Home?
What Is the Medical Treatment for Vaginal Prolapse?
What Medications Are Used to Treat Vaginal Prolapse?
What Is Vaginal Prolapse Surgery? What Is the Recovery Time?
What Is Alternative Therapy for Vaginal Prolapse?
What Is the Follow-up for Vaginal Prolapse?
What Is the Prognosis for Vaginal Prolapse?

Lazarou, GL, MD, et al. Uterine Prolapse. Medscape. Updated: Aug 15, 2018.

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The network of muscles, ligaments, and skin in and around a woman's vagina acts as a complex support structure that holds pelvic organs, and tissues in place. This support network includes the skin and muscles of the vaginal walls (a network of tissues called the fascia). Various parts of this support system may eventually weaken or break, causing a common condition called vaginal prolapse.
Vaginal prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall out of their normal positions. Without medical treatment or surgery, these structures may eventually prolapse farther and farther into the vagina or even through the vaginal opening if their supports weaken enough.
The symptoms that result from vaginal prolapse commonly affect sexual function as well as bodily functions such as urination and defecation. Pelvic pressure and discomfort are also common symptoms.
Symptoms most commonly associated with a vaginal prolapse depend on the type of vaginal 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.
General symptoms that may be seen with all types of vaginal prolapse include pressure in the vagina or pelvis, painful intercourse ( dyspareunia ), a mass at the opening of the vagina, decrease in pain or pressure when lying down, and recurrent urinary tract infections .
Some women who develop a vaginal prolapse do not experience symptoms.
A network of muscles provides the main support for the pelvic viscera (the vagina and the surrounding tissues and organs within the pelvis). The major part of this network of muscles, which is located below most of the pelvic organs and supports the organs' weight, is called the levator ani. Pelvic ligaments provide additional stabilizing support.
When parts of this support network are weakened or damaged, the vagina and surrounding structures may lose some or all of the support that holds them in place. Collectively, this condition is called pelvic relaxation. A vaginal prolapse occurs when the weight-bearing or stabilizing structures that keep the vagina in place weaken or deteriorate. This may cause the supports for the rectum, bladder, uterus, small bladder, urethra, or a combination of them to become less stable.
Common factors that may cause a vaginal prolapse include:
A large percentage of women develop some form of vaginal prolapse during their lifetime, most commonly following menopause , childbirth, or a hysterectomy. Most women who develop this condition are older than 40 years of age. Many women who develop the symptoms of a vaginal prolapse do not seek medical help because of embarrassment or other reasons. Some women who develop a vaginal prolapse do not experience symptoms.
There are different types of vaginal prolapse:
This type of vaginal prolapse involves a prolapse of the back wall of the vagina (rectovaginal fascia). When this wall weakens, the rectal wall pushes against the vaginal wall, creating a bulge. This bulge may become especially noticeable during bowel movements.
This can occur when the front wall of the vagina (pubocervical fascia) prolapses. As a result, the bladder may prolapse into the vagina. When this condition occurs, the urethra usually prolapses as well. A urethral prolapse is also called a urethrocele. When both the bladder and urethra prolapse, this condition is known as a cystourethrocele. Urinary stress incontinence (urine leakage during coughing , sneezing, exercise , etc) is a common symptom of this condition.
The weakening of the upper vaginal supports can cause this type of vaginal prolapse. This condition primarily occurs following a hysterectomy. An enterocele results when the front and back walls of the vagina separate, allowing the intestines to push against the vaginal skin.
This involves a weakening of a group of ligaments called the uterosacral ligaments at the top of the vagina. This causes the uterus to fall, which commonly causes both the front and back walls of the vagina to weaken as well. Stages of uterine prolapse are:
This type of prolapse may occur following a hysterectomy (surgical removal of the uterus). Because the ligaments surrounding the uterus provide support for the top of the vagina, this condition is common after a hysterectomy. In vaginal vault prolapse, the top of the vagina gradually falls toward the vaginal opening. This may cause the walls of the vagina to weaken as well. Eventually, the top of the vagina may protrude out of the body through the vaginal opening, ultimately turning the vagina inside out. A vaginal vault prolapse is often accompanied by an enterocele.
Any woman who experiences symptoms that may indicate a vaginal prolapse should contact her doctor.
Vaginal prolapse is rarely a life-threatening condition. However, most prolapses gradually worsen and can only be corrected with intravaginal pessaries or surgery. Thus, timely medical care is recommended to evaluate for and to prevent problematic symptoms and complications caused by weakening tissue and muscles surrounding the vagina.
Generally, the most reliable way that a doctor can make a definite diagnosis of any type of vaginal prolapse involves a medical history and a thorough physical examination. This involves the doctor examining each section of the vagina separately to determine the type and extent of the prolapse in order to decide which type of treatment is most appropriate.
During the physical examination, a woman may need to sit in an upright position and strain so that any prolapsed tissues are more likely to become apparent. Some types of vaginal prolapse such as cystocele or rectocele are more easily identifiable during the physical examination than are types such as vaginal vault prolapse or enterocele.
Since many women with vaginal prolapse also have urinary incontinence , these tests can further evaluate the anatomy and function of the pelvic floor.
Most vaginal prolapses will gradually worsen over time and can only be fully corrected with surgery. However, the type of treatment that is appropriate to treat a vaginal prolapse depends on factors such as the cause and severity of the prolapse, whether the woman is sexually active, her age and overall medical status, her desire for future childbearing, and her personal preference.
Treatments at home for vaginal prolapse include the following:
Many women with vaginal prolapse may benefit from estrogen replacement therapy. Estrogen helps strengthen and maintain muscles in the vagina. As with hormone therapy for other indications, the benefits and risks of estrogen therapy must be weighed for each individual patient.
Estrogen replacement therapy may be used to help the body strengthen the muscles in and around the vagina. Estrogen replacement therapy may be contraindicated (such as in a people with certain types of cancer ) and has been associated with certain health risks including increased risk of blood clots and stroke , particularly in older postmenopausal women. Women's bodies cease producing estrogen naturally after menopause, and the muscles of the vagina may weaken as a result.
In mild cases of vaginal prolapse, estrogen may be prescribed in an attempt to reverse vaginal prolapse symptoms, such as vaginal weakening and incontinence. For more severe prolapses, estrogen replacement therapy may be used along with other types of treatment.
A generalized weakness of the vaginal muscles and ligaments is much more likely to develop than isolated defects. If a woman develops symptoms of one type of vaginal prolapse, she is likely to have or develop other types as well. Therefore, a thorough physical examination is necessary for the surgeon to detail what surgical steps are necessary to correct the vaginal prolapse completely. The typical surgical strategy is to correct all vaginal weaknesses at one time.
Surgery is usually performed while the woman is under general anesthesia. Some women receive a spinal or epidural. The type of anesthesia given usually depends on the anticipated length of the surgical procedure. Laparoscopic surgery is a minimally invasive surgical procedure that involves slender instruments and advanced camera systems. This surgical technique is becoming more common for securing the vaginal vault after a hysterectomy and correcting some types of vaginal prolapse such as enteroceles or uterine prolapses.
Women who undergo surgery for vaginal prolapse repair should normally expect to spend 2-4 days in the hospital depending on the type and extent of the surgery. After surgery, women are usually advised to avoid heavy lifting for approximately 6-9 weeks. After surgery, most women can expect to return to a normal level of activity after 3 months. A woman undergoing treatment should schedule follow-up visits with her doctor to evaluate progress. Pessaries need to be removed and cleaned at regular intervals to prevent infection.
Physical therapy such as electrical stimulation and biofeedback may be used to help strengthen the muscles in the pelvis.
After surgery, most women can expect to return to a normal level of activity after 3 months.
A woman undergoing treatment should schedule follow-up visits with her doctor to evaluate progress. Pessaries need to be removed and cleaned at regular intervals to prevent infection.
Vaginal prolapse is rarely a life-threatening condition.
Vaginal prolapse surgery is generally successful but recurrence remains an issue.
Women at risk for vaginal prolapse (including those who have had corrective surgery) should, if possible, avoid heavy lifting or any activity that increases pressure within the abdominal cavity.
Obesity puts extra stress on the muscles and ligaments within the pelvis and vagina. Weight reduction can help prevent this condition from developing or recurring.
What were the symptoms of your vaginal prolapse?
What was the treatment for your vaginal prolapse?
Please describe your experience with vaginal prolapse surgery.
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Vaginal prolapse is a condition in which the muscles supporting the muscles in the pelvis weaken and stretch, allowing the bladder, uterus and or bowel to protrude into the vagina. The condition rarely involves the vagina alone. This protrusion can cause complications such as abdominal pain, problems with bowel movements, issues with urinary function and even difficult sexual
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