Vaginal prolapse occurs when the vagina shifts from its normal position due to weakened and overstretched pelvic muscles and tissues. This condition is more prevalent in individuals who have undergone multiple vaginal deliveries during childbirth and have reached menopause. The three types of vaginal prolapse include rectocele, cystocele, and vaginal vault prolapse.
Symptoms of Vaginal Prolapse
Typically, individuals might experience vaginal pressure from sagging organs, lower abdominal fullness, constipation, vagina pain during intercourse, vaginal bleeding, pulling in the groin or lower back, or urinary incontinence. They may also encounter a frequent urge to urinate or nocturia. Symptoms can worsen with activities like standing, lifting, or vigorous exercise such as jumping.
Type of Vaginal Prolapse: Rectocele
A rectocele refers to an unusual protrusion of the front wall of the rectum into the rear wall of the vagina. The rectum is the lower part of the colon.
While a minor rectocele often remains asymptomatic, a significant one can result in a visible protrusion into the vagina, accompanied by the following symptoms:
- Rectal discomfort
- Constipation
- Fecal impaction within the rectal bulge
- Difficulty achieving complete bowel evacuation
- Frequent urges for bowel movements
- Straining during bowel movements
- Vaginal bleeding
- Feeling of vaginal fullness
- Need to apply pressure against the vagina or the space between the rectum and vagina during defecatio
- Discomfort during sexual intercourse
Type of Vaginal Prolapse: Cystocele
Bladder prolapse, known as cystocele, happens when the muscles and tissues supporting the bladder weaken or stretch, leading to the bladder descending or protruding into the vagina. In severe cases, the prolapsed bladder may be visible at the vaginal opening.
Women with a cystocele may exhibit these symptoms:
- Seeing or feeling a vaginal protrusion
- Urinary incontinence
- Incomplete emptying of the bladder post-voidin
- Increased frequency of urination or urgency to urinate
- Decreased urine flow rate
- Pain during intercourse
- Discomfort in the pelvic, vaginal, lower abdominal, lower back, or groin regions
- Tender and/or bleeding tissue protruding from the vagina
- Sensation of heaviness or pressure in the vaginal region
Diagnosing Vaginal Prolapse
The initial step involves an internal pelvic assessment. Patients are required to remove clothing from the waist down and recline on an examination bed. The physician then checks the pelvic region and vaginal interior for any abnormalities. A speculum may be utilized to widen the vaginal walls and detect prolapse.
Certain patients may be requested to assume a left-side lying position for enhanced prolapse visibility. Further diagnostic measures may include urinalysis to detect infections and cystoscopy for bladder examination.
Treatment Options for Vaginal Prolapse
Nonsurgical interventions are typically preferred initially, especially for minimal or mild prolapses. These treatments may include:
- Pelvic Muscle Exercises: Strengthen pelvic muscles through Kegel exercises, involving tightening these muscles as if halting urination, holding for a few seconds, and releasing. Repeat this ten times, up to four times daily, anywhere.
- Vaginal Pessary: A small plastic or rubber doughnut-shaped device placed in the vagina provides support, fitted and inserted by a healthcare provider. It requires frequent cleaning and removal before intercourse.
For more severe cases, surgical correction may be necessary:
- Vaginal Vault Suspension: Attaches the vagina to pelvic ligaments for support.
- Sacrocolpopexy: Uses mesh to lift the vagina, securing it to the tailbone via laparoscopic abdominal surgery.
- Colpocleisis: Involves stitching the vagina closed, offering low risk of recurrence but prohibits penetrative intercourse post-procedure.