Vaginal Prolapse

Prolapse is a condition in which one or more of the pelvic organs comes down or bulges into or out of the vagina, often with the sensation of ‘something coming down below’. The pelvic organs consist of the uterus, bowel and bladder. Pelvic organ prolapse occurs when the network of supporting tissues that holds these organs in their correct positions become weakened.

Types of Vaginal Prolapse

  • Cystocoele is a herniation of back wall of bladder into the front wall of vagina
  • Rectocoele is a herniation of the front wall of the rectum into the back wall of the vagina
  • Urethrocoele is the prolapse of the female urethra into the vagina.
  • Enterocoele involves the small bowel herniating into the vagina
  • Uterine and cervical prolapse occurs when the uterus and cervix slip down into or protrudes out of the vagina.
  • Vaginal vault prolapse following hysterectomy occurs when the upper portion of the vagina loses its normal shape and drops down into the vaginal canal or outside of the vagina 

Symptoms

  • Women may have some of the following symptoms:
  • A heavy dragging feeling in the vagina or lower back
  • Feeling of a lump in the vagina or outside the vagina
  • Urinary problems such as slow stream, incomplete bladder emptying, frequency, urgency and stress urinary incontinence
  • Bowel problems such as difficulty moving the bowel or a feeling of incomplete emptying
  • Dyspareunia [pain during sex]

Risk Factors

  • Stretching and weakening of ligaments and muscles such as childbirth, pelvic mass and menopause
  • Increased intra-abdominal pressure such as obesity, chronic coughing, chronic constipation, profession involving heavy lifting
  • Pelvic surgery such as hysterectomy
  • Diseases of the nervous system - pelvic organ prolapse is more common in women who have multiple sclerosis, muscular dystrophy, or a spinal cord injury than in women who do not have such conditions
  • Genetic factors - a weakness in the supportive tissue of the pelvis can be passed through families 

Treatments

  • Pelvic floor exercise supervised by physiotherapist for milder cases
  • Pessary supporting device
  • Surgical repair