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Vaginal Prolapse by Krisha McCoy, MS

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

Risk Factors

Increasing age increases your risk of vaginal prolapse. Other factors include:

Multiple vaginal deliveries
Post-menopause
Obesity
Straining caused by chronic cough, constipation, or heavy lifting
Family history

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

Your doctor will ask about your symptoms and medical history. A physical exam will also be done. Vaginal prolapse that has no symptoms may be diagnosed during routine examinations. Your doctor may refer you to a gynecologist, who will do a pelvic exam.

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

Your doctor may recommend estrogen therapy. This may help prevent further weakness of the pelvic floor.

Pessary Insertion

Your doctor may insert a pessary 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, to suture the vagina.

If you are diagnosed with vaginal prolapse, follow your doctor's instructions.

Prevention

To help prevent 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, quit. Smoking may cause chronic coughing and weakening of connective tissues.
Limit heavy lifting.

RESOURCES:

American Congress of Obstetricians and Gynecologists http://www.acog.org
US Department of Health and Human Services 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 website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated January 22, 2013. Accessed April 22, 2013.
Pelvic organ prolapse. International Urogynecological Association website. Available at: http://www.iuga.org/resource/resmgr/Brochures/eng_pop.pdf. Published 2011. Accessed April 22, 2013.
Pelvic relaxation syndromes. Merck Manual for Health Care Professionals. Available at: http://www.merckmanuals.com/professional/gynecology_and_obstetrics/pelvic_relaxation_syndromes/overview_of_pelvic_relaxation_syndromes.html. Updated February 2012. Accessed April 22, 2013.
5/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: 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.

Last reviewed April 2013 by Andrea Chisholm; Brian Randall, MD

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