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Vaginal Prolapse: Diagnosis, Treatment & What to Expect

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Summary of Part One

Vaginal prolapse is a common condition where the bladder, uterus, and/or bowel protrudes into the vagina and the vagina slips out of position. It is more common in women who have had multiple vaginal deliveries during childbirth, have gone through menopause, are smokers, and/or are overweight. The chance of developing a prolapse increases as you age.

This can cause symptoms such as a sensation of a vaginal lump, constipation, difficulty emptying the bowel/bladder, or problems with sexual intercourse. We only recommend treatment when the prolapse is symptomatic. 

The biggest contributor of prolapse is pregnancy and vaginal birth, although a number of other factors such as lifestyle, family history and certain medical conditions can also contribute to prolapse. Treatment varies from simple lifestyle changes to surgery but regardless of the treatment option chosen, vaginal prolapse can come back.

How is it diagnosed?

Vaginal prolapse is diagnosed with a pelvic exam.

During the exam, the doctor might ask their patient to tighten and release the muscles they’d use to stop and start the flow of urine. This test checks the strength of the muscles that support their vagina, uterus, and other pelvic organs. Their doctor might ask them to tighten their sphincter as if they’re trying to push out a bowel movement.

If they have trouble urinating, the doctor may run urodynamic tests to check their patient’s bladder function.

● A uroflowmetry measures the strength and amount of their urine stream.

● A cystometrogram determines how full their bladder needs to get before they have to use the bathroom.

Their doctor might also do one or more of these imaging tests to look for problems with their pelvic organs:

 Pelvic ultrasound: this test uses sound waves to check their bladder and other organs.

●  Pelvic floor MRI: this test uses strong magnets and radio waves to take pictures of their pelvic organs.

● CT scan of your abdomen and pelvis: this test uses an X-ray to create detailed pictures of their pelvic organs.

How common is vaginal prolapse?

Vaginal prolapse is fairly common, about 3.3 million women (or more than 1/3rd of women in the U.S.) have some type of pelvic prolapse over the course of their lifetime. A patient is more likely to experience a vaginal prolapse later in life, especially if this patient has had multiple pregnancies with vaginal births.

How is prolapse treated?

The kind of treatment a patient have will depend on:

● The prolapse type and stage

● The patient’s age, health, and medical history

● Whether or not they want to give birth to children in the future.

Types of treatments include:

● Lifestyle changes to stop doing the things that may have caused the prolapse or could make it worse. Life changes could mean losing weight, quitting smoking, eating and drinking differently, and/or lifting less. The goal of making lifestyle changes is usually to fix the prolapse. 

● Physiotherapy to strengthen the pelvic floor that supports their organs. A physiotherapist can design a special pelvic exercise program for you. The goal of physiotherapy is to fix prolapses.

● A pessary, which is a small plastic or silicon support, is placed inside their vagina to hold up the prolapsed organ. Pessaries don’t fix prolapses but they can reduce or lessen the symptoms, which helps the patient live more comfortably. 

● Surgery to repair the stretched or torn pelvic floor. There are several types of prolapse surgery but the goal of all of them is to try to fix the prolapse and prevent it from happening again. However, some surgeries will mean the patient can no longer have biological children. 

Typically, a doctor will recommend the most conservative treatment methods first, like pelvic floor exercises. Unfortunately, treatment is not always successful and sometimes a prolapse will come back. 

What should a patient expect?

If you have any symptoms of vaginal prolapse, including a feeling of fullness in your lower belly or a bulge in your vagina, please call our office to make an appointment at (530) 345-0064, ext. 281. We want to assure you not to worry because this condition isn’t dangerous, however, it can have a negative effect on your quality of life.

Vaginal prolapse is treatable. Milder cases can improve with noninvasive treatments like Kegel exercises and weight loss. For more severe cases, surgery can be effective. However, it’s important for patients to know that vaginal prolapse can sometimes come back, even after intensive treatment methods like surgery.

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