Vaginal Prolapse Overview
The network of muscles, ligaments, and skin in and around
a woman's vagina acts as a complex support structure that holds pelvic organs,
and tissues in place. This support network includes the skin and
muscles of the vagina walls (a network of tissues called the fascia). Various parts of this support system may eventually weaken or break, causing a common condition called vaginal prolapse.
A vaginal prolapse is a condition in which structures such
as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may
begin to prolapse, or fall out of their normal positions. Without medical
treatment or surgery, these structures may eventually prolapse farther and
farther into the vagina or even through the vaginal opening if their supports weaken enough.
The symptoms that result from vaginal prolapse commonly affect sexual function
as well as bodily functions such as urination and defecation. Pelvic pressure and discomfort are also common symptoms.
The following are types of vaginal prolapse:
of the rectum): This type of vaginal prolapse involves a prolapse of the back
wall of the vagina (rectovaginal fascia). When this wall weakens, the rectal
wall pushes against the vaginal wall, creating a bulge. This bulge may become
especially noticeable during bowel movements.
- Cystocele (prolapse
of the bladder, bladder drop): This can occur when the front wall of the
vagina (pubocervical fascia) prolapses. As a result, the bladder may prolapse
into the vagina. When this condition occurs, the urethra usually prolapses as
well. A urethral prolapse is also called a urethrocele. When both the bladder
and urethra prolapse, this condition is known as a cystourethrocele.
stress incontinence (urine
leakage during coughing, sneezing, exercise, etc) is a common symptom of this
- Enterocele (herniated small bowel): The weakening of the upper vaginal supports can cause this type of vaginal prolapse. This condition primarily occurs following a hysterectomy. An
enterocele results when the front and back walls of the vagina separate,
allowing the intestines to push against the vaginal skin.
- Prolapsed uterus
(womb): This involves a weakening of a group of ligaments called the uterosacral ligaments at the top of the vagina. This causes the uterus to fall, which commonly causes both the front and back walls of the vagina to weaken as well. The following are stages of uterine prolapse:
- First-degree prolapse: The uterus droops into the
upper portion of the vagina.
- Second-degree prolapse: The uterus falls into the
lower part of the vagina.
- Third-degree prolapse: The cervix, which is located
at the bottom of the uterus, sags to the vaginal opening and may protrude
outside the body. This condition is also called procidentia, or complete
- Fourth-degree prolapse: The entire uterus protrudes entirely outside the vagina. This condition is also called procidentia, or complete prolapse.
Vaginal vault prolapse: This type of prolapse may occur following a hysterectomy, which involves the removal of the uterus. Because the uterus provides support for the top of the vagina, this condition is common after a hysterectomy, with upwards of 10% of women developing a vaginal vault prolapse after undergoing a hysterectomy. In vaginal vault prolapse, the top of the vagina gradually falls toward the vaginal opening. This may cause the walls of the vagina to weaken as well. Eventually, the top of the vagina may protrude out of the body through the vaginal opening, effectively turning the vagina inside out. A vaginal vault prolapse often accompanies an enterocele.
Approximately 30%-40% of women develop some presentation of vaginal prolapse in their lifetime, usually following
menopause, childbirth, or a hysterectomy. Most women who develop this condition are older than 40 years
of age. Many women who develop symptoms of a vaginal prolapse do not seek medical help because of embarrassment or other reasons. Some women who develop a vaginal prolapse do not experience symptoms.
George Lazarou, MD, FACOG
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