Vaginal Prolapse

Vaginal prolapse, pelvic floor prolapse, or pelvic organ prolapse (POP) can be diagnosed and treated at the Urology Division and the Women’s Center for Continence and Sexual Health at Premier Medical Group.

What is vaginal prolapse?

Vaginal prolapse, pelvic floor prolapse, or pelvic organ prolapse (POP), occurs when the structures of the pelvis protrude into or outside of the vaginal canal. Frequent sites of pelvic organ prolapse include the bladder, urethra, uterus, vagina, small bowel, or rectum. The vagina is a muscular tube that supports all these. The condition is experienced almost entirely by adult women and more common in women who have had a hysterectomy or multiple childbirths. A weakness in any area of the vaginal canal or its support structures can allow one or more of the various types of prolapse to occur.

What are the causes of pelvic organ prolapse?

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Pelvic organ prolapse is caused most commonly by pregnancy, labor, and childbirth. During labor, the nerves of the vagina may be compressed and injured by the movement of the baby through the birth canal. Damage to the nerves in the pelvis can also be caused by a forceps delivery or an episiotomy. Diseases that cause increased pressure in the abdomen, such as obesity, respiratory problems with a long-lasting (chronic) cough, constipation, and pelvic organ cancers can also lead to pelvic organ prolapse. The condition can also occur after hysterectomy for another gynecological health problem, such as endometriosis, dysfunctional uterine bleeding, or uterine fibroids.

What are the symptoms of pelvic organ prolapse?

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Some women have no pronounced symptoms of POP. Others may experience a noticeable bulge or lump in the vagina, as organs sag or protrude into the vaginal wall. Common symptoms may include:

  • A feeling of heaviness in the vaginal area
  • Something protruding from the vagina
  • A stretching or pulling sense in the pelvic area
  • Pain when you stand
  • Pain with sexual intercourse
  • Vaginal pain, pressure, bleeding, spotting or irritation
  • Recurrent lower back pain
  • Sporadic loss of bladder or bowel control
  • Trouble with bowel movements
  • Difficult or painful urination
  • Abdominal pain

How is pelvic organ prolapse diagnosed?

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Diagnosis begins with a complete medical history and a physical examination, often including pelvic examination. In some cases, further tests may be ordered such as diagnostic and imaging tests. Often a pelvic examination is performed.

What are the types of pelvic organ prolapse?

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It’s possible for several of these prolapses to occur at the same time.

Vaginal vault prolapse

This is when the apex, or upper portion of the vagina, collapses and descends into the vaginal canal. This occasionally happens after a hysterectomy, causing the vagina to turn inside out.

Bladder prolapse (Cystocele)

This is when the wall between the vagina and the bladder deteriorates, which can cause the bladder to sag or drop into the vagina.

Urethral prolapse

This happens when the tube that carries urine from the bladder loses support, resulting in the urethral tube sagging or bulging down into the vagina.

Rectal prolapse (Rectocele)

When front wall of the rectum sags and pushes against the vaginal wall, causing a bulge.

Intestinal prolapse (Enterocele)

This is when the small intestine pushes and bulges into the upper back vaginal wall.

How is pelvic organ prolapse treated?

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If you are diagnosed with pelvic organ prolapse (POP), you can be treated by urologist, a gynecologist, a urogynecologist, or a physical therapist. Your treatment will depend on the severity of the condition and your symptoms.

Often this condition slowly worsens over time and ultimately requires surgery. With milder cases, your doctor may suggest that you refrain from heavy lifting, and suggest Kegel exercises. Sometimes estrogen therapy is used. Depending on the severity of the POP, Kegel exercises can help to improve your condition, but the patient needs to perform these exercises correctly.

Kegel exercises

Kegals should be done 10 – 15 times each, at least 3 times a day. Do not do the exercise while urinating.

There are two types of Kegel exercises:

  • Slow contractions: contract the sphincter muscle and hold to a count of 3, gradually increasing to a count of 10
  • Quick contractions: rapidly tighten and relax the sphincter muscle

Biofeedback

This is sometimes used together with Kegel exercises to support a proper method. A special device records tiny electrical signals that are produced when muscles contract. These signals are changed into audio and/or visual signs that help patients understand the impact of their exercise and gain greater control over urinary and bowel muscle activity. Muscles can be relaxed with this procedure and it can prove quite helpful.

Neuromuscular electrical stimulation

This is electrical stimulation of nerves in the pelvic area that cause pelvic floor and urethral and anal sphincter muscles to contract. Your doctor will insert a probe into the vagina and a current is passed through the probe at a level below the pain threshold, causing a contraction. You will need to squeeze the muscles when the current is on. After the contraction, the current is switched off for 5 to 10 seconds.

Pelvic organ prolapse surgery

In severe cases that do not respond to more conservative treatment, surgery may be necessary. There are new and more effective options today for POP. Surgery is performed under regional or general anesthesia, and may be performed laparoscopically through the abdomen, or vaginally. Surgery may require grafts, mesh like materials or slings. These newer techniques have markedly reduced the morbidity associated with these repairs. Patients are now most often discharged within a day of surgery.