Vaginal prolapse (cystocele, fallen bladder, rectocele, uterine prolapse) is when the organs inside of the pelvis, such as the uterus, urethra and bladder, protrude toward or through the opening of the vagina. This is caused by a weakness in the pelvic floor, which is the sheet of muscle and connective tissue that stretches from the pubic bone to the tailbone and surrounds the vagina, rectum, bladder and uterus. The pelvic floor’s job is to hold these pelvic organs in place, but when it weakens the organs can fall out of their positions and stop functioning normally.
The most obvious symptom of vaginal prolapse is a bulge protruding from the opening of the vagina. Additional symptoms of vaginal prolapse are pelvic pressure, discomfort, feeling as if something is falling out, difficulty emptying the bladder, unwanted urine leakage, difficulty emptying the rectum, fecal incontinence and experiencing a sense of looseness during sexual intercourse.
Even though more than 40 percent of all women experience some degree of prolapse in their lifetime, 14 million in the U.S. alone, the exact cause is unknown. However, risk factors include pregnancy, vaginal delivery, hysterectomy, obesity, chronic cough, chronic constipation, repetitive heavy lifting, menopause and genetic connective tissue weakness.
The presence and severity of vaginal prolapse are determined during a pelvic exam. During this exam, the anterior vaginal wall, posterior vaginal wall, top of the vagina and uterus are each evaluated for prolapse. After the exam, a stage from 0 to IV is assigned. A stage 0 prolapse means there is no prolapse present. A stage I prolapse means that the vaginal wall bulges down to three centimeters inside the opening of the vagina. A stage II prolapse means that the vaginal wall comes to or slightly through the opening. A stage III prolapse is when the vaginal wall protrudes several centimeters outside of the vagina. A stage IV prolapse is when the entire vaginal wall protrudes through the opening.
Vaginal Prolapse Treatments
There are both non-surgical and surgical treatment options available for vaginal prolapse. Options vary depending on the stage of prolapse. While the surgical treatment options are minimally invasive, a one-night hospital stay is usually required.
Non-surgical treatment options include:
- Kegel exercises
- Pelvic floor therapy
- Vaginal pessary
Surgical treatment options include:
- Anterior colporrhaphy
- Paravaginal defect repair
- Posterior colporrhaphy
- Vaginal vault suspension
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