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Definition

Vaginal prolapse implies that the vagina is stretched so that its front wall bulges (a cystocele) or its back wall bulges (a rectocele) when a woman strains down, for example in having a bowel movement.

Description

Aging may produce changes in women's pelvic structures, creating an opportunity for a variety of problems. Loss of tone in the muscular components of the pelvic sling and stretching of ligaments may sometimes lead to protrusion of pelvic structures through the vaginal introitus (opening). In vaginal prolapse, the supports of the uterus are also stretched, so that it too prolapses down when a woman strains, and the cervix of the uterus may protrude outside of the vagina. When the anterior wall of the vagina and the bladder or urethra are involved, the protrusion is a cystocele or a cystourethrocele. When the posterior wall of the vagina and the rectum or small bowel are affected, the result is a rectocele or enterocele, respectively. Loss of support for the uterus results in protrusion of the uterine body into the vaginal barrel. When the protrusion extends into the upper portions of the vagina, it is described as a first-degree prolapse. When the protrusion extends to the vaginal introitus, it is a second-degree prolapse. When prolapse is complete, with protrusion of the cervix into the introitus (opening), the condition is described as procidentia, or third-degree prolapse.

Causes

Aging and the birthing process can be associated with the development of vaginal prolapse.

Diagnosis

Diagnosis is usually made by medical history and physical examination, including a pelvic exam and/or rectal exam.

Treatment

Non-surgical treatment of these conditions involves placing an object (pessary) into the vagina to support surrounding structures. The wide variety of available pessaries permits rather precise choice of pessary to meet a given patient's needs. In elderly women, a basic ring structure may suffice. This may consist of a collapsible ring device or a ring attached to a semi-rigid stalk. If these devices are not adequate or the pelvic structures are too relaxed to permit retention of a ring, an inflated donut-shaped ring or a ring that is inflated on insertion should be considered. Another variation is a collapsible cube made of surgical plastic that resumes its shape after insertion into the vagina. If the vaginal introitus is constricted, a large tampon that is changed often may function adequately as a pessary. Not all women can use a pessary. If this is the case, surgical intervention may be the only effective approach. An obstetrician-gynecologist will explain the risks and benefits of surgical treatment with you. Surgical repair is based on the fascial and muscular support defects as well as on the functional demands and limitations of the patient. Colpocleisis, or closure of the vagina, is an alternative to surgical repair, but is unacceptable for a sexually active woman.

Questions

Are there any signs or symptoms? Is it first-degree, second-degree or third-degree prolapse? Is there evidence of cystocele or rectocele? Will the prolapsed vagina have an effect on sexual relations? carrying and delivering children? Are there any other non-evasive treatments that would help the condition? Will Kegel exercises help in strengthening the vaginal muscles?