Vaginal prolapse is a protrusion of the vaginal walls and the pelvic organs that they support toward or through the opening of the vagina. This occurs as a result of pelvic floor weakness. The "pelvic floor" is a sheet of muscle and connective tissue that stretches from the pubic bone to the tailbone and surrounds the vagina, rectum, bladder and uterus. The pelvic floor holds these pelvic organs in their appropriate positons in the pelvis. If the pelvic floor is weak, these organs fall out of their usual positions and do not function normally.
There are different types of vaginal prolapse depending on what part of the vagina has lost support from the pelvic floor. An anterior vaginal wall prolapse, often referred to as a "cystocele" or "fallen bladder" occurs when the wall between the bladder and vagina has weakened. A posterior vaginal wall prolapse, also called "rectocele" is caused by a weakening of the wall between the vagina and the rectum. A uterine prolapse occurs when the ligaments that hold the uterus in place at the top of the vagina stretch or break allowing the uterus to drop into the vaginal canal. When the uterus is removed during a hysterectomy, the top of the vagina can cave inward toward or through the opening of the vagina. This is called a "vault prolapse" or "enterocele".
The most obvious symptom of vaginal prolapse is a bulge protruding from the opening of the vagina. This bulge is the vaginal wall and can become irritated and bleed if it rubs against clothing. Vaginal prolapse can cause pelvic pressure, discomfort, or a sense that "something is falling out". An anterior vaginal wall prolapse (cystocele or fallen bladder) can lead to difficulty emptying the bladder (urinary retention). Urinary retention can result in urinary tract (bladder) infections. Unwanted leakage of urine (urinary incontinence) is also associated with anterior vaginal wall prolapse. A posterior vaginal wall prolapse (rectocele) can cause difficulty emptying the rectum, fecal incontinence, or a sense of looseness with sexual intercourse. Any type of vaginal prolapse can obstruct vaginal penetration with intercourse or cause a woman to be self-conscious in intimate situations.
Greater than 40% of women demonstrate some degree of prolapse. The exact cause of vaginal prolapse is unknown. It is not understood why some women have prolapse while others with similar risk factors do not. Risk factors for the development of vaginal prolapse are pregnancy, vaginal delivery, hysterectomy, obesity, chronic cough, chronic constipation, repetitive heavy lifting, menopause, and genetic connective tissue weakness.
The presence and severity of vaginal prolapse are determined during a pelvic exam. The anterior vaginal wall, posterior vaginal wall, top of the vagina, and uterus are each evaluated for prolapse. A stage from 0 to IV is assigned to each part of the vagina depending on how close the prolapsing part comes to or through the opening of the vagina. A stage 0 prolapse means there is no prolapse present. A stage I prolapse means that the vaginal wall bulges down to three centimeters inside the opening of the vagina. A stage II prolapse means that the vaginal wall comes to or slightly through the opening. A stage III prolapse is when the vaginal wall protrudes several centimeters outside of the vagina. A stage IV prolapse is when the entire vagina protrudes through the opening.
Both non-surgical and surgical options are available for the treatment of vaginal prolapse.
NON-SURGICAL TREATMENT OPTIONS FOR VAGINAL PROLAPSE
Kegel exercises strengthen the pelvic floor muscles to give more support to the pelvic organs and slow the progression of vaginal prolapse. Kegel exercises can be done at home but must be done correctly and regularly to work.
Pelvic Floor Therapy
Pelvic floor therapy consists of a series of visits to a physical therapist who has specialized training in the treatment of pelvic floor problems. The physical therapist uses techniques to help women strengthen the pelvic floor muscles that hold the pelvic organs in their proper positions. Click here for more information on pelvic floor therapy.
A vaginal pessary is a removable diaphragm-like device worn in the vagina to support vaginal prolapse and/or decrease stress urinary incontinence. There are a variety of types and sizes of pessaries available. A pessary fitting includes two or more office visits to find a type and size of pessary that will work for you. Click here for more information on vaginal pessaries.
The Colpexin™ Sphere Intravaginal Device
The Colpexin™ Sphere is a device that is worn in the vagina. It allows for the elevation of vaginal prolapse so that Kegel exercises can be performed more effectively. Click here for more information on the Colpexin™ Sphere.
SURGICAL TREATMENT OPTIONS FOR VAGINAL PROLAPSE
Minimally invasive surgery is available to repair vaginal prolapse. Surgery is most often done vaginally and usually requires a one-night hospital stay. The type of surgery will be chosen based on what type of prolapse is present.
Anterior Colporrhaphy (Anterior Repair)
An anterior colporrhaphy repairs the wall between the vagina and the bladder. A piece of material called a "graft" can be placed between the vagina and bladder to strengthen the repair. There are many types of grafts available.
Paravaginal Defect Repair
Another type of anterior vaginal wall repair is a paravaginal defect repair. This surgery reattaches the sidewalls of the vagina to their normal attachments in the pelvis. This procedure can be performed vaginally or abdominally.
Posterior Colporrhaphy (Posterior Repair)
A posterior colporrhaphy repairs the wall between the vagina and the rectum. As with an anterior colporrhaphy, graft material can be used to strengthen this type of repair. This procedure is performed vaginally.
Perineorrhaphy (Perineal Repair)
A perineorrhaphy is the surgical repair of a weakened perineum (the area between the vaginal opening and the anus). This procedure is sometimes done with a posterior repair.
Vaginal Vault Suspension
A vaginal vault suspension repairs a vaginal vault prolapse by attaching the top of the vagina to ligaments in the pelvis with permanent sutures or graft material. This procedure can be performed vaginally or abdominally.
A hysterectomy is the removal of the uterus. This is done for severe uterine prolapse. A hysterectomy can be done through a vaginal or abdominal incision.
The Prolift™ is a minimally invasive type of surgery to repair any type of vaginal prolapse. Specifically shaped pieces of synthetic graft material are inserted through an incision in the vagina and positioned with needle-like surgical instruments. An anterior, posterior, or total Prolift™ is performed depending on the type of prolapse present. The Prolift™ can be done with or without a hysterectomy. Click here for more information on the Prolift™.