Do you experience any of the following symptoms: pelvic pressure, difficulty emptying your bladder, or a feeling of fullness in your vagina? If so, you may have vaginal prolapse.
Vaginal prolapse, a common yet challenging condition, can be a source of discomfort and struggle for many women.
While vaginal prolapse can be uncomfortable and embarrassing, it is important to remember that you are not alone. Numerous treatment options are available, and with proper care, you can lead a full and active life.
In this informative article, we’ll delve into the world of vaginal prolapse, addressing the different types and the various treatment options available for you. Join us as we demystify a topic that is often shrouded in silence and stigma and learn how women can take proactive steps to regain control and live life to the fullest.
Understanding Vaginal Prolapse
In cases of vaginal prolapse, also referred to as pelvic organ prolapse, the upper part of the vagina moves down from its usual position in the body. This displacement can result in other pelvic organs drooping into the vaginal canal, creating a feeling of a lump or bulge.
Our pelvis holds various organs, which are supported by muscles and tissues forming the pelvic floor. Over time, these supporting structures can weaken, resulting in the prolapse, or descent, of pelvic organs. Vaginal prolapse specifically refers to the weakening and descent of the upper part of the vagina.
Cleveland Clinic notes that the severity of vaginal prolapse can vary. A small prolapse is called an incomplete prolapse, while a more significant one is termed a complete prolapse, involving a noticeable shift in organ position. In severe cases, the organs can protrude from the vaginal opening, which is a serious condition.
Types of Vaginal Prolapse
There are several types of vaginal prolapse, depending on which pelvic organ is affected:
#1 Cystocele (Anterior Vaginal Prolapse)
Anterior Prolapse, also called a prolapsed bladder, fallen bladder, or cystocele, happens when the tissue between the bladder and vaginal wall becomes weakened, resulting in the bladder bulging into the vagina.
This weakening of the pelvic muscles can happen due to various factors such as vaginal childbirth, straining during constipation, heavy lifting, or persistent coughing. The decline in estrogen levels during menopause can also play a role in the occurrence of anterior prolapse.
#2 Uterine Prolapse
Uterine prolapse is a condition that arises when the muscles and tissues in the pelvic area weaken, causing the uterus to descend into the vaginal cavity. In some cases, it may even protrude through the vaginal opening. Remarkably, nearly half of women aged 50 to 79 experience this condition.
The primary cause of uterine prolapse is the weakening of the pelvic floor muscles and tissues, which are unable to provide adequate support for the weight of the uterus. This lack of support results in the descent of the uterus into the vaginal region.
#3 Rectocele (Posterior Vaginal Prolapse)
A rectocele is a distinct form of prolapse that arises when the connective tissue barrier between a woman’s rectum and vaginal wall loses its strength. When the muscles and ligaments in the pelvic floor can’t offer adequate support, the anterior wall of the rectum droops and pushes into the vagina. In more serious instances, it may extend beyond the vaginal opening.
Multiple factors, including pregnancy, childbirth, aging, and obesity, can contribute to the formation of a rectocele.
An enterocele, often referred to as a small bowel prolapse, is a form of pelvic organ prolapse. It takes place when the small intestine prolapses or descends, leading to a noticeable bulge within the vagina.
Women who have entered the postmenopausal stage and those who have experienced childbirth are more susceptible to the development of enteroceles.
Management options for enteroceles typically include the use of pessary devices and engaging in Kegel exercises, which are pelvic floor exercises designed to provide support and alleviate symptoms.
#5 Vaginal Vault Prolapse
Vaginal vault prolapse, as per the International Continence Society’s definition, is the downward displacement of the vaginal cuff to a position 2 cm less than the overall length of the vagina from the hymen’s plane. In simpler terms, this happens when the vagina’s top portion bulges either into or outside the vaginal canal.
Generally speaking, pelvic organ prolapse occurs when a woman’s pelvic floor muscles, tissues, and ligaments lose strength and elasticity, leading to the shifting of organs from their typical locations.
Vaginal prolapse, specifically, refers to the sagging and descent of the top of the vagina, known as the vaginal vault, into the vaginal canal. In severe instances, the vagina can even protrude outside the body.
Several factors, including multiple vaginal deliveries, use of instrumental vaginal delivery, and rare conditions from birth, such as bladder exstrophy, can contribute to the risk of vaginal vault prolapse.
Vaginal Prolapse Treatment
Your healthcare provider will assess several factors when devising a treatment plan for vaginal prolapse:
- General Health and Other Medical Conditions: Your overall health and the presence of other medical issues play a significant role in determining the appropriate treatment.
- Age: Age can impact the choice of treatment as younger individuals may have different considerations than older ones.
- Severity of Prolapse: The extent to which the prolapse has progressed will influence the treatment options.
- Future Plans: Your healthcare provider will consider whether you plan to have children or engage in penetrative sex in the future.
Having an open and honest conversation with your healthcare provider about these factors is crucial to making informed decisions about your treatment.
Nonsurgical Treatment Options
Nonsurgical treatments are typically the initial choice, particularly for mild to moderate vaginal prolapse cases. These options aim to provide support and strengthen the pelvic muscles:
Kegel Exercises: Kegel exercises focus on the pelvic floor muscles, requiring you to contract and release them as if you’re halting the flow of urine. Incorporating Kegel exercises into your routine can enhance muscle tone and provide better support for the pelvic region.
Vaginal Pessary: A vaginal pessary is a device resembling a small plastic or rubber doughnut that is inserted into the vagina. It acts as a supportive structure, preventing the prolapse from worsening. Your healthcare provider will fit you for the appropriate pessary, and it requires regular cleaning and removal before sexual activity.
Surgical Treatment Options
For more severe cases of vaginal prolapse, surgical interventions may be necessary. These options provide more comprehensive support and restoration of the pelvic structures:
Vaginal Vault Suspension: In this procedure, the vagina is attached to the ligaments inside the pelvis that normally hold it in place. This reattachment helps restore the natural position of the vaginal vault.
Sacrocolpopexy: Sacrocolpopexy involves attaching a mesh to the vagina and securing it to the tailbone to provide support and lift the vaginal walls. This surgery is performed through the abdomen using minimally invasive techniques, such as laparoscopy.
Transvaginal Mesh: Transvaginal mesh is a medical implant designed in a net-like structure to address conditions such as stress urinary incontinence and pelvic organ prolapse in women.
The use of surgical mesh for pelvic organ prolapse (POP) repair has faced significant challenges, leading to the FDA’s decision to prohibit its sales for this specific purpose in 2019, as stated by TruLaw.
The use of mesh in such procedures posed considerable risks, including complications like mesh erosion, infections, discomfort during intercourse, and damage to adjacent pelvic organs.
Consequently, the Transvaginal Mesh Lawsuit has been initiated to seek accountability from manufacturers for the physical and financial hardships caused by these medical devices.
So, what can be used instead of mesh for prolapse? Well, there are several viable options available to treat pelvic organ prolapse without relying on the mesh. These alternatives include native tissue repair, biological graft repair, and pubovaginal slings, offering patients a range of choices to address their condition while avoiding the associated risks of surgical mesh.
Colpocleisis: Colpocleisis is a procedure in which the vagina is surgically closed or partially stitched shut. While it effectively minimizes the risk of future prolapses, it also means you can no longer engage in penetrative sex after the procedure.
The choice between nonsurgical and surgical treatments depends on the individual circumstances and the severity of the vaginal prolapse. It’s crucial to discuss with your healthcare provider to identify the most appropriate treatment plan tailored to your individual needs and objectives.
Vaginal prolapse is indeed a prevalent condition, affecting approximately 50 percent of women to some extent. It’s worth noting that over 12 percent of American women will undergo surgery for this condition during their lifetime.
While vaginal prolapse can cause discomfort and various symptoms, it’s essential to understand that effective treatment options are available, enabling women to regain control of their lives and maintain an active lifestyle.
This article has shed light on the different types of vaginal prolapse, their causes, and potential treatments. It emphasizes the significance of open and honest discussions with healthcare providers to make informed decisions about the appropriate treatment plan.
The key is to tailor the approach to individual circumstances and the severity of the condition, aiming to improve the quality of life for women experiencing vaginal prolapse.