Vaginal Prolapse

Overview

Definition

Vaginal prolapse is the inward and downward bulging of the vaginal walls. The severity of vaginal prolapse may be defined as:

  • First degree—collapse into the upper part of the vagina
  • Second degree—collapse further into the vaginal canal, down to the level of the vaginal opening
  • Third degree—collapse that extends beyond the opening

Causes

Vaginal prolapse is caused by weakened support structures in the pelvic region. The lack of support causes the walls of the vagina to weaken, sag, and collapse.

Pelvic Floor Muscles and Organs
Pelvic floor muscels
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Risk Factors

Your risk of vaginal prolapse increases with age. Other factors include:

  • Multiple vaginal deliveries
  • Postmenopause
  • Obesity
  • Straining caused by chronic cough, constipation, or heavy lifting
  • Family history

SymptomsandDiagnosis

Symptoms

Symptoms may include:

  • Pelvic pressure
  • A feeling of vaginal fullness or heaviness
  • A feeling of pulling in the pelvis
  • Vaginal discomfort
  • Urinary urgency and frequency
  • Urination when laughing, sneezing, coughing, or exercising
  • Constipation
  • Difficult or painful intercourse
  • Low backache that is relieved with lying down

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Vaginal prolapse that has no symptoms may be diagnosed during routine examinations. You may be referred to a gynecologist, who will do a pelvic exam.

Treatments

Treatment

Talk with your doctor about the best treatment plan for you. First- or second-degree prolapse without symptoms may not require treatment. Treatment options include:

Kegel Exercises

Kegel exercises involve tensing the muscles around the vagina and anus, holding for several seconds, then releasing. The repetition of this exercise will help to tone pelvic muscles.

Medications

Estrogen therapy may be advised. This may help prevent further weakness of the pelvic floor.

Pessary Insertion

A pessary may be inserted into the upper portion of the vagina. A pessary is a rubbery, doughnut-shaped device. It helps to prop up the uterus and bladder. Pessary placement is more often used in older women.

Surgery

Vaginal prolapse that is severe or associated with lasting symptoms may require surgery. Surgery may involve repairing the pelvic floor structure or, in some cases, suturing the vagina.

Prevention

To help reduce your chance of vaginal prolapse:

  • Do Kegel exercises.
  • Maintain a healthy weight.
  • To avoid constipation, eat plenty of fruits, vegetables, and whole grains. Drink plenty of fluids throughout the day.
  • If you smoke, talk to your doctor about ways to quit. Smoking may cause chronic coughing and weakening of connective tissues.
  • Limit heavy lifting.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Pelvic Floor Relaxation)

RESOURCES

American Congress of Obstetricians and Gynecologists http://www.acog.org 

Office on Women's Health http://www.womenshealth.gov 

CANADIAN RESOURCES

Canadian Women's Health Network http://www.cwhn.ca 

Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org 

References

Pelvic organ prolapse. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T114467/Pelvic-organ-prolapse . Updated March 23, 2015. Accessed September 27, 2016.

Pelvic organ prolapse. International Urogynecological Association website. Available at: http://c.ymcdn.com/sites/www.iuga.org/resource/resmgr/Brochures/eng%5Fpop.pdf. Published 2011. Accessed March 8, 2016.

Uterine and vaginal prolapse. The Merck Manual Professional Edition. Available at: http://www.merckmanuals.com/professional/gynecology%5Fand%5Fobstetrics/pelvic%5Frelaxation%5Fsyndromes/uterine%5Fand%5Fvaginal%5Fprolapse.html. Updated December 2013. Accessed March 8, 2016.

Vaginal pessary. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/drugs-procedures-devices/procedures-devices/vaginal-pessary.html. Updated May 2014. Accessed March 8, 2016.

5/11/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114467/Pelvic-organ-prolapse: Fritel X, Varnoux N, Zins M, Breart G, Ringa V. Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors. Obstet Gynecol. 2009;113:609-616.