Vaginal Prolapse: All You Need to Know
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The muscles, tissues, and ligaments in the pelvis collectively form the pelvic floor support, which holds the pelvic organs in place for women. This article delves into the vaginal prolapse symptoms, treatment options, and more. Prolapse occurs when these supportive structures weaken, leading to an inability to maintain the position of the pelvic organs. Uro-genital prolapse refers to the symptomatic descent of one or more of the following:

  • The front (bladder) vaginal wall
  • The back (bowel) vaginal wall
  • The apex (top) of the vagina (cervix or uterus) or the vault (cuff) after a hysterectomy

Various degrees of prolapse exist, including:

  • First-degree prolapse: In this condition, the uterus partially descends into the vagina.
  • Second-degree prolapse: In this, the uterus reaches the vaginal opening.
  • Third-degree prolapse: It’s characterised by the uterus partially protruding outside the vagina.
  • Complete Procidentia: Here, the uterus descends below and outside the vagina.

Prolapse symptoms

Most women will experience symptoms, including:

  • They often describe a ‘dragging sensation’ (if something has dropped below).
  • They may feel pelvic pressure and or lower back pain.
  • They might notice bladder symptoms like urinary frequency and a persistent feeling of incomplete bladder emptying after urination.
  • Bowel symptoms may arise, leading to difficulty emptying the bowels and sometimes accompanied by changes in bowel control.
  • Sexual intercourse can become challenging.
  • They may also face recurrent urinary tract infections.

Prolapse causes

Childbirth is the most common cause, as it involves the weight of the developing baby on the pelvic floor and the stretching of pelvic floor muscles and support structures during vaginal delivery, which can lead to bladder, bowel, and uterine prolapse.

  • Prior hysterectomy increases the risk of prolapse.
  • Excess weight or obesity contributes to pelvic floor strain and weakness.
  • Pelvic floor straining, like heavy weight lifting, straining during bowel movements, and chronic constipation, can damage the pelvic floor muscles.
  • Menopause causes a decrease in oestrogen levels, which maintains the strength of vaginal muscles.
  • Genetic factors can also play a role in pelvic floor weakness, as it can run in families.

Prolapse treatment

Millions of women experience pelvic organ prolapse, often after childbirth weakens their pelvic floor muscles, causing organs to descend into the vagina. This condition, also known as pelvic floor prolapse, significantly impacts their quality of life. Fortunately, various treatment options are available, each tailored to the woman’s needs and symptoms, considering factors like sexual activity and future childbearing plans. These treatment options include:

  • Making lifestyle changes as a conservative approach
  • Using vaginal pessaries
  • Undergoing surgical procedures

Conservative Prolapse Treatment

Many women may not require treatment for pelvic prolapse, as the issue often resolves on its own without significantly disrupting their daily lives.

However, there are conservative prolapse treatment options available that are low-risk and involve simple lifestyle adjustments. These include reducing or eliminating activities that involve straining, such as avoiding heavy lifting. Health professionals also advise continuing to perform pelvic floor exercises (Kegels) and maintaining a healthy body weight.

Furthermore, we recommend a high-fiber diet to prevent constipation and avoid extra strain on these muscles during bowel movements. If you are a smoker, your doctor will encourage you to quit it, as coughing can worsen prolapse.

If these treatments prove ineffective, your healthcare provider may suggest undergoing a pelvic floor muscle strengthening program under the guidance of a dedicated physiotherapist. It is also crucial for preventing the recurrence of prolapse after surgery or the development of a new prolapse in the vaginal area, where prolapse was not previously present.

Vaginal Pessary for Prolapse

Many women often wonder how to address prolapse without resorting to surgery. When conservative methods fail to alleviate prolapse symptoms, healthcare professionals may recommend a vaginal device.

One of the most common devices employed is the ring pessary, a removable device inserted into the vagina to support the prolapsed organs and keep them in their proper position.

Ring pessaries are favored due to their compatibility with sexual intercourse, as they do not obstruct the vagina. While they require replacement every six months, they should generally go unnoticed and not interfere with any desired activities.

Alternative options to the ring device include a shelf, Gellhorn, and cube pessaries or their variations. These devices block the vagina and do not support sexual activity, except for the cube pessary, which enables patients to self-insert and remove it, allowing them to take it out and reinsert it before and after sexual intercourse.

Vaginal pessary devices offer the advantage of posing significantly lower risks than surgery. They can be inserted and replaced in an outpatient setting without anesthesia.

However, it’s important to note that these devices have their drawbacks. For instance, ring pessaries may experience issues like displacement, where the prolapse ring may shift from its intended position within the vagina, despite attempts to use different sizes or devices.

Additionally, this method requires ongoing treatment and repeated appointments, which may not be practical for some women. Finally, these devices can induce vaginal discharge, which some women may find unpleasant.

Pelvic Floor Surgery

Pelvic organ prolapse causes persistent pain and discomfort, and if lifestyle adjustments or pessaries don’t offer relief, surgery may become the preferred solution. Nearly 1 in 10 women undergo pelvic floor surgery by the time they reach the age of 80, making it a relatively general procedure.

There are various surgical options available to women experiencing symptoms of vaginal prolapse. The choice of surgery depends on factors such as the organs involved, the severity of the prolapse, and any existing medical conditions. These surgical options encompass vaginal repair, vaginal hysterectomy, procedures that preserve the uterus, and vaginal and perineal reconstruction.

Final verdict

At our Top Gynaecologists London clinic, we primarily perform prolapse surgeries using minimally invasive techniques through the vaginal route. This approach eliminates the need for abdominal incisions or stitches, resulting in quicker recovery and shorter hospital stays. Additionally, our team includes advanced laparoscopic surgeons, offering a range of laparoscopic procedures.

Our service operates collaboratively, providing a comprehensive gynaecological care package. Our consultants frequently work together to manage women with other gynaecological conditions closely linked to prolapse or pelvic floor issues, such as menstrual problems and endometriosis.

Mahantesh Karoshi
Mahantesh Karoshi

I'm a Consultant Obstetrician & Gynaecologist and Women's Health Expert. I believe in educating my patients to contribute to achieving the best possible clinical and holistic outcomes. By taking this approach, I enable and empower my patients whilst addressing their issues and concerns. I run a private practice with an extremely high standard of professionalism. My patients are directly involved in their care and management in all stages. My approach to my patient's problems is built on dedication and passion, drawing on analytical thinking and my on-time honored reading, teaching medical professionals nationally and internationally.