Doctor's Notes on Vaginal Prolapse Symptoms, Causes, Treatment, and Surgery Repair
Vaginal prolapse describes the situation in which pelvic organs such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself begin to lose their normal position and sink into the vagina. Eventually, prolapsed structures may even pass through the vaginal opening if their supporting tissues become weak enough. Prolapse occurs when the supporting tissues such as skin and muscles of the pelvis weaken or lose their capacity to support the pelvic organs.
A sensation that tissues in the vagina are out of place is the most common symptom. There may be a protrusion or sense of pressure in the vaginal area. Associated symptoms and signs can include pressure in the vagina or pelvis, painful sexual intercourse (dyspareunia), urinary tract infection, problems emptying the bowels, constipation, and leakage of urine (stress incontinence).
Vaginal Prolapse Symptoms, Causes, Treatment, and Surgery Repair Symptoms
Symptoms most commonly associated with a vaginal prolapse depend on the type of vaginal prolapse present. The most common symptom of all types of vaginal prolapse is the sensation that tissues or structures in the vagina are out of place. Some women describe the feeling as "something coming down" or as a dragging sensation. This may involve a protrusion or pressure in the area of the sensation. Generally, the more advanced the prolapse, the more severe the symptoms.
General symptoms that may be seen with of all types of vaginal prolapse include pressure in the vagina or pelvis, painful intercourse (dyspareunia), a mass at the opening of the vagina, a decrease in pain or pressure when the woman lies down, and recurrent urinary tract infections.Symptoms specific to certain types of vaginal prolapse include:
- Difficulty emptying bowel: This may be indicative of an enterocele, vaginal vault prolapse, or rectocele. A woman with difficulty emptying her bowel may find that she needs to place her fingers on the back wall of the vagina to help evacuate her bowel completely. This is referred to as splinting.
- Difficulty emptying bladder: This may be secondary to a cystocele, urethrocele, enterocele, vaginal vault prolapse, or prolapsed uterus.
- Constipation: This is the most common symptom of a rectocele.
- Urinary stress incontinence: This is a common symptom often seen in combination with a cystocele.
- Pain that increases during long periods of standing: This may be indicative of an enterocele, vaginal vault prolapse, or prolapsed uterus.
- Protrusion of tissue at the back wall of the vagina: This is a common symptom of a rectocele.
- Protrusion of tissue at the front wall of the vagina: This is a common symptom of a cystocele or urethrocele.
- Enlarged, wide, and gaping vaginal opening: This is a physical finding frequently seen in combination with a vaginal vault prolapse.
Some women who develop a vaginal prolapse do not experience symptoms.
Vaginal Prolapse Symptoms, Causes, Treatment, and Surgery Repair Causes
A network of muscles provides the main support for the pelvic viscera (the vagina and the surrounding tissues and organs within the pelvis). The major part of this network of muscles, which is located below most of the pelvic organs and supports the organs' weight, is called the levator ani. Pelvic ligaments provide additional stabilizing support.
When parts of this support network are weakened or damaged, the vagina and surrounding structures may lose some or all of the support that holds them in place. Collectively, this condition is called pelvic relaxation. A vaginal prolapse occurs when the weight-bearing or stabilizing structures that keep the vagina in place weaken or deteriorate. This may cause the supports for the rectum, bladder, uterus, small bladder, urethra, or a combination of them to become less stable.
Common factors that may cause a vaginal prolapse
Childbirth (especially large babies): Childbirth is damaging to the tissues, muscles, and ligaments in and around the vagina. Long, difficult labors and large babies are especially stressful to these structures. Childbirth is the risk factor most commonly associated with cystoceles, in which the bladder prolapses into the vagina. A cystocele is sometimes accompanied by a urethrocele, in which the urethra becomes displaced and prolapses. A cystocele and urethrocele together are called a cystourethrocele.
Menopause: Estrogen is the hormone that helps to keep the muscles and tissues of the pelvic support structures strong. After menopause, the estrogen level declines; and the support structures may weaken.
Hysterectomy: The uterus is an important part of the support structure at the top of the vagina. A hysterectomy involves removing the uterus. Without the uterus, the top of the vagina may gradually fall toward the vaginal opening. This condition is called a vaginal vault prolapse. As the top of the vagina falls, added stress is placed on other ligaments. Hysterectomy is also commonly associated with an enterocele, in which the small intestine herniates downward near the top of the vagina.
Other risk factors of vaginal prolapse include advanced age, obesity, dysfunction of the nerves and tissues, abnormalities of the connective tissue, strenuous physical activity, and prior pelvic surgery.
Menopause is not a disease, but rather the point in a woman's life at which she is no longer fertile, and menstrual periods have ceased. During this time, ovulation stops and estrogen hormones drop. Menopause can be accompanied by physical symptoms in some women, like hot flashes or night sweats. Menopause is the time point at which a woman has not had a menstrual period for 12 months. Perimenopause is the time leading up to menopause, and the symptoms of the transition can take two to ten years. Menopause can be seen as a positive beginning of a new phase of life, with opportunities to take preventive action against major health risks.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.