Vaginal prolapse or pelvic organ prolapse occurs when pelvic organs, including the bladder, uterus, or rectum, descend into the vaginal canal due to the weakening of muscles and ligaments within the pelvic floor. It affects a significant number of women, with research indicating that approximately 40% of women experience some degree of prolapse during their lifetime. This prevalence varies with age, childbirth history, and other factors.

Vaginal prolapse can have a profound impact on women's quality of life, leading to discomfort, urinary and bowel issues, sexual dysfunction, and emotional distress. Early diagnosis and appropriate management are crucial in improving vaginal prolapse surgery success rates and overall well-being.

Types of Vaginal Prolapse

The type of vaginal prolapse varies based on the pelvic floor tissues involved:

• Anterior vaginal prolapse (Cystocele): A condition where the bladder drops into the vagina.
• Posterior vaginal prolapse (Rectocele): A condition where the rectum droops into the vagina.
• Uterine prolapse: A condition that happens when the uterus descends into the vaginal canal.
• Vaginal Vault Prolapse: A condition where the top of the vagina (cervix) slips into the vagina.

Causes of Vaginal Prolapse

Uterine prolapse commonly arises due to the following:

• Multiple childbirths
• Vaginal delivery
• Late first pregnancy
• Giving birth to a large baby
• Advancing age
• Obesity
• Prior pelvic surgery.
• Chronic constipation
• Weak connective tissues
• Weakness of pelvic floor muscles
• Hormonal changes
• Chronic coughing

Symptoms of Vaginal Prolapse

Here are some symptoms of uterine prolapse that you should be aware of and watch for:

• Pressure or heavy feeling on the pelvis
• Lower back pain
• Feeling that something is coming out of your vagina
• Painful sexual intercourse
• Difficulty with urination or moving your bowels
• Discomfort while walking
• Urinary incontinence
• Vaginal prolapse can affect adjacent organs like the bladder and rectum, leading to discomfort, and urinary and bowel issues due to compromised pelvic support.

Diagnosis of Vaginal Prolapse

• Medical history and physical examination: Your healthcare provider will ask you questions about your medical history to assess the risk factors that might contribute to vaginal prolapse. If your physician suspects a prolapsed uterus, they will conduct a pelvic examination to assess your condition. Additionally, you may need to get a cystoscopy and MRI to obtain a more detailed view of your pelvic organs.
• Pelvic organ prolapse quantification (POP-Q) system: Your healthcare provider will use the POP-Q system to measure the extent of prolapse and determine the specific organs involved. This standardized evaluation allows for accurate staging of the prolapse, aiding in treatment decisions.
• Additional tests and imaging: In some cases, additional tests and imaging might be necessary to assess the severity of the prolapse or identify any underlying conditions. Tests like urodynamic studies or pelvic ultrasound may be used to gather more information for tailored treatment options.

Non-Surgical Treatment Options

• Pelvic floor exercises (Kegel exercises): Strengthening the pelvic floor muscles through Kegel exercises can improve support for the pelvic organs and alleviate symptoms of vaginal prolapse.
• Pessaries: Pessaries are probably the most commonly used non-surgical options for vaginal prolapse. They are removable devices prosthetic inserted into the vagina to provide support for prolapsed organs.
  • Ring Pessary: It is a circular device inserted inside the vagina to help support vaginal walls.
  • Gellhorn Pessary: This device is shaped like a gourd and helps treat advanced prolapse by providing strong support.
  • Cube Pessary: It is a cube-shaped pessary that can be adjusted for comfort and helps treat various types of prolapse.
  • Donut Pessary: It is a circular pessary with a hole in the middle that supports the vaginal wall and helps address prolapse and incontinence.
• Hormone therapy: Hormone therapy, like estrogen replacement, can improve vaginal tissue health and elasticity, reducing the impact of prolapse in postmenopausal women.
• Pelvic support braces: Numerous pelvic support braces and garments are available in the market for women managing pelvic organ prolapse. FemiCushion stands out as specialized pelvic support device providing prolapse support through its unique silicone cushion. This device not only alleviates discomfort but also plays a crucial role in preventing the progression of the prolapse over time.
• Lifestyle modifications: Lifestyle changes, such as weight management, avoiding heavy lifting, and treating constipation and cough, can help manage and reduce symptoms associated with vaginal prolapse.

Surgical Treatment Options

Your doctor may advise surgical approaches for vaginal prolapse when conservative therapies fail.

• Vaginal repair techniques involve repairing prolapsed organs and strengthening the pelvic floor through procedures like anterior/posterior colporrhaphy. These techniques have shorter recovery times and do not require abdominal incisions but may not be suitable for complex cases.

• Abdominal repair procedures, like sacrohysteropexy or sacrocolpopexy, are performed through an abdominal incision to address complex pelvic organ prolapse or uterine issues. These procedures provide durable results, but they involve longer recovery periods and increased risk of complications.

• Minimally invasive approaches like Laparoscopic or robotic surgeries offer less invasive options for repairing pelvic organ prolapse and urinary incontinence, reducing recovery time and scarring. These minimally invasive procedures offer reduced postoperative pain, faster recovery, and better cosmetic outcomes, but they may require specialized skills and equipment.

Recovery and Aftercare

After surgery, you may be subjected to a short hospital stay for observation and pain management. Your healthcare provider will provide you with instructions on wound care and hygiene for speedy recovery and aftercare for vaginal prolapse treatment. You would need to follow them diligently to promote healing and prevent infections.

Daily activities can be reintroduce in your life gradually. Your healthcare provider will advise you to avoid heavy lifting and strenuous exercise initially. Consult your doctor about the appropriate timeline to resume normal activities and exercise routines. 

You would also need to attend follow-up appointments periodically so that your doctor can assess your healing progress and address any concerns. Regular monitoring will also help in the early detection of potential issues and ensures the success of your recovery.

Prevention of Vaginal Prolapse and Self-Care Tips

• Pelvic floor exercises and physical therapy: The risk of vaginal prolapse can be reduced by performing Kegel exercises regularly. These exercises will help strengthen the pelvic floor muscles and improve muscle tone and support.

• Maintaining a healthy weight also helps reduce pressure on the pelvic organs, decreasing the risk of prolapse.

• Proper lifting techniques: Lifting heavy objects improperly can also increase the risks of vaginal prolapse. Proper lifting techniques, such as lifting heavy objects by bending your knees, rather than your waist, can help avoid putting strain on the pelvic area. 

• Managing Chronic Conditions that Contribute to Prolapse: Addressing conditions like chronic cough, constipation, or conditions leading to increased abdominal pressure can also contribute to preventing prolapse.

Addressing Psychological and Emotional Aspects

Being diagnosed with vaginal prolapse can be quite overwhelming. The apprehension and anxiety associated with the condition and its treatment can take a toll on your emotional and psychological state.

Support groups specific to pelvic organ prolapse, online forums, and counseling services can offer a safe space to share experiences and emotions. Additionally, educational materials from reputable medical sources can provide insights and coping strategies for managing the emotional aspects of the diagnosis.

Conclusion

Understanding vaginal prolapse and its treatment options is essential for making informed decisions. From pelvic floor exercises to hormone therapy and pessaries, various non-surgical vaginal prolapse management options exist. However, for more severe cases, surgical intervention may be inevitable. Regular pelvic check-ups can help in the early detection and timely management of vaginal prolapse. We encourage women to prioritize their pelvic health fosters a proactive approach to managing vaginal prolapse and leads to improved quality of life.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.