Vaginal Prolapse

A network of ligaments, muscles and skin occupy the space in and around the vagina, providing support for all pelvic organs, tissues and structures. Weakness in the system can cause organs to fall—or prolapse—into the vaginal opening or even through it.

Symptoms of Vaginal Prolapse

These are some indicators that you may be suffering from vaginal prolapse. Keep in mind that some women experience no symptoms at all.

  • The sensation that something in the vagina is out of place
  • Protrusion or pressure in the vagina
  • Pain or pressure that decreases when reclining
  • Painful intercourse
  • Recurrent urinary tract infections
  • Stress incontinence

Types of Vaginal Prolapse

  • Cystocele – Caused by the prolapse of the front vaginal wall, cyctocele is the falling of the bladder. This usually also causes the subsequent prolapse of the urethra, called urethrocele. The two prolapses in combination are called cystourethrocele.
  • Rectocele – A prolapse of the back vaginal wall can cause bulging of the rectum. This may be noticeable during bowel movements.
  • Enterocele – The weakening of the upper vaginal area can cause a herniated small bowel. This can occur after hysterectomy, when a separation between front and back vaginal walls allow the intestinesto push against the vaginal skin.
  • Prolapsed Uterus – When the group of ligaments at the top of the vagina weaken, it starts a chain reaction. The uterus falls, which can weaken both the front and back vaginal walls. There are four degrees of uterine prolapse:
    • First – The uterus droops into the upper portion of the vagina
    • Second – The uterus falls into the lower portion of the vagina
    • Third – The cervix sags into the vaginal opening or, in the case of procidentia (complete prolapse),can protrude outside the body
    • Fourth – The uterus itself protrudes outside the body (also procidentia)
  • Vaginal Vault Prolapse – After hysterectomy, the top support of the vagina is gone. The vaginal walls weaken, and the top of the uterus can then slide toward the vaginal opening, sometimes protruding from the body. This can be accompanied by an enterocele.

Causes of Vaginal Prolapse

  • Menopause – Estrogen keeps the support structure strong. After menopause, the drop in estrogen makes the structure loosen.
  • Hysterectomy – The uterus itself is an important part of the pelvic support structure. Hysterectomy removes the uterus, taking away the connection for the top of the vagina. This can then begin to droop, which in turn stresses other ligaments. Hysterectomy most often leads to enterocele.
  • Childbirth – Long, difficult births, giving birth to multiples and large babies put extra stress on an already-stressed system. The most-common type of prolapse associated with childbirth is cyctocele, then urethrocele.
  • Menopause – A drop in estrogen after menopause can weaken the structures in the pelvis.
  • Obesity
  • Advanced age
  • Strenuous activity
  • Dysfunctional/abnormal nerves and tissues
  • Pelvic surgery

Vaginal Prolapse Diagnosis

One-third of women can suffer from vaginal prolapse. It’s rarely life-threatening, but since prolapses get worse with time, it’s best to seek answers as soon as symptoms occur. Methods of diagnosis include:

  • Physical exam – This is the best way to find a prolapse. Your doctor will examine each part of the vagina, usually while you are seated. This allows the prolapse to be more readily discovered.
  • Urodynamics
  • Examination of urethra/bladder neck
  • Test of pelvic floor strength
  • MRI (magnetic resonance imaging) scan
  • Ultrasound
  • Conduct cystourethroscopy – The insertion of a small tube into the urethra for internal viewing of the urethra and bladder

Vaginal Prolapse Treatment

Non-Surgical Options

  • Biofeedback – A sensor monitors muscle activity in the vagina and pelvic floor while the patient performs exercises. Sometimes, these exercises can relieve or even reverse symptoms, while the sensor indicates the effectiveness of the therapy.
  • Electrical Stimulation – Your doctor will insert a probe into targeted muscles in the vagina and pelvic floor, delivering small electrical currents. These currents stimulate the muscles, causing them to contract and strengthen.

Surgical Treatment of Vaginal Prolapse

Though surgeries vary, they usually require two to four days of hospitalization and you should refrain from heavy lifting for two weeks to six months.

  • For Cystocele and Rectocele – The surgeon accesses the affected area through the vagina, usually working through an incision in the vaginal wall to push the organ back into place. Then it is secured into its normal position and excess tissue is removed before closing the vaginal wall.
  • For Urethrocele – The surgeon performs a bladder neck suspension procedure, which places a sling to support the bladder.
  • For Vaginal Vault Prolapse – Depending on the severity of the condition, the surgeon will work either through the vagina (less severe) or the abdomen (most severe). A vaginal vault suspension is performed, attaching the vagina to strong pelvis tissue or to the sacrum, a bone at the base of the spine.
  • For Prolapsed Uterus – If you are post-menopausal or don’t want to have more children, the surgeon will perform a hysterectomy, usually through the vagina.

Robotic Sacro-Colpopexy

Decreased hospital stays. Quicker recovery. Decreased morbidity. These are the main patient benefits of robot-assisted laparascopic surgery. Advanced robot technology gives a surgeon magnified and controlled motion, letting complex procedures occur through an incision no larger than a keyhole. Dr. Kassahun is highly trained in using the da Vinci® Surgical System and has performed numerous robotic sacrocopexy procedures.