What is vaginal prolapse?
Vaginal prolapse is when the vagina drops from its typical location in the body. The vagina is the tunnel that connects the uterus to the outside of a woman’s body and it is called the birth canal. The vagina is one of several organs that rests in the pelvic area of the female body. These organs are held in place by muscles and other tissue. These muscles come together to create a support structure. Throughout a patient’s life, this support structure can start to weaken. This can happen for a variety of reasons, but the result is sagging of your organs. When your organs sag or droop out of their normal position, this is referred to as a prolapse.
Depending on the degree of movement, prolapses can be considered small or large. A small prolapse is called incomplete prolapse. A larger prolapse is called a complete prolapse and this is where the organ has shifted significantly. A very severe prolapse can even result in part of the organ protruding out of the body.
What causes vaginal prolapse?
The pelvic floor muscles function as a hammock of muscles that support your pelvic organs. Childbirth can stretch and weaken these muscles, especially if you had a difficult delivery.
In fact, the biggest cause of prolapse is pregnancy and birth, almost 50% of women who have been pregnant will have some kind of prolapse. This is because the pelvic floor is weakened during pregnancy by the extra weight and hormone changes, and then again when you give birth. A patient is more likely to experience prolapse if they have had more than one baby, their baby was over nine pounds at birth or they had to push during delivery for a long time.
Extra pressure on your abdominal area, caused by certain activities or conditions, can also cause a prolapse.
Additionally, the natural process of aging and the loss of estrogen during menopause can further weaken these muscles, allowing the pelvic organs to drop down into the vagina.
A patient is more likely to have a vaginal prolapse if:
● They have a family history of prolapse. A naturally weaker pelvic support system can be passed down throughout their family through genetics.
● They regularly lift heavy things (like furniture, older children, etc.) or they regularly do extreme physical activity. Strain from activity can weaken pelvic muscles and allow organs to sag out of position.
● They have fibroids or a pelvic tumor.
● They are overweight.
● They have chronic constipation which leads to them straining to have a bowel movement.
● They have a chronic cough (such as smokers or people with lung conditions like asthma or bronchitis).
● They have had a procedure like a hysterectomy, or radiation treatment in the pelvic area.
● They have had menopause, which means their ovaries stop producing hormones that regulate their monthly menstrual cycle (period). The hormone estrogen is particularly important because it helps keep their pelvic muscles strong. When their body doesn’t make as much estrogen as before, those pelvic muscles can become weak and prolapse can develop.
What are the signs of prolapse?
In many cases, a patient may not experience any symptoms from prolapse and these patients typically find out about their vaginal prolapse during an exam. However, if a patient does experience signs or symptoms, they can include:
● Their vagina may feel heavy or like it is dragging. This may be more noticeable at the end of the day, when they cough or sneeze when they have been standing for a long period of time or have done something very physical such as running.
● They may see or feel a lump. This can be inside their vagina or poking out of it.
● They may have achy pain in their back or pelvic region.
● They may have difficulty going to the toilet. They might need to urinate a lot, have trouble emptying their bladder or bowel, or accidentally urinate.
● They have a chronic urinary tract infection (UTI). Vaginal prolapse gives patients an increased risk for developing UTIs.
● Some women report that they have problems inserting tampons or problems during sex.
● Some patients also experience sores in the vagina if the uterus or cervix bulges through.
Why does vaginal prolapse happen?
When the muscles that support the organs in a woman’s pelvis weaken, vaginal prolapse happens. This weakening can be caused by a variety of factors but it allows the uterus, urethra, bladder, or rectum to drop down into the vagina. If the pelvic floor muscles weaken enough and the vaginal prolapse gets to a higher stage, these organs can move down further and protrude out of the vagina.
Are there different types of prolapse?
Yes, several of the organs in your pelvic area can shift out of place which can develop into a prolapse. There are a few different types of prolapse, including:
● Anterior vaginal prolapse (cystocele and/or urethrocele)
○ Cystocele happens when the bladder falls down into the vagina.
○ Urethrocele happens when the urethra (the tube that carries urine away from the bladder) bulges into the vagina. Cystocele and urethrocele are typically found together.
● Posterior vaginal prolapse (rectocele) is when the wall separating the rectum from the vagina weakens, and this lets the rectum to bulge into the vagina.
● Uterine prolapse is when the uterus drops down into the vagina, sometimes so far that it comes out of the vaginal opening.
● Apical prolapse (vaginal vault prolapse) is when the cervix or upper part of the vagina falls down into the vagina.
○ Enterocele is when the small intestine bulges against the back wall of the vagina. An enterocele and vaginal vault prolapse often occur together.
Come back next week for part two where we will discuss the diagnosis, prevalence, and treatment of vaginal prolapse.