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Women's Health Newsletter

Vaginal Prolapse Problems

Vaginal Prolapse is a condition in which the organs in the pelvis lose their support & drop into the vagina. This problem usually develops in women after childbirth & slowly worsens with time. Some women are more prone to this based on their genetic make-up & how "stretchy" or weak their tissues are. Studies have suggested that women may be more prone to developing vaginal prolapse when they are young depending on their genetic makeup. Weakness in the tissues also results in more  severe vaginal prolapse. Mild forms of vaginal prolapse may not cause any symptoms & be followed without treatment. More severe vaginal prolapse can cause difficulty with urination & bowel movements, urine loss with activity, difficulty with sex, & discomfort with exercise. It can cause low back pain, pelvic pressure, & pelvic discomfort; & these symptoms often worsen throughout the day.

Click  here for information about the treatment of vaginal prolapse

This diagram shows normal pelvic  support viewed from the side.

Types of Prolapse- “Prolapse” means that something is bulging into something else. In the case of vaginal prolapse, the organs next to the vagina are bulging into the vagina, essentially creating a hernia. Another term we use is "pelvic organ prolapse" because the organs which surround the vagina are what are causing the bulge. There are different terms for the types of prolapse depending on what part of the vagina is involved. On exam these can look very similar, & it is often takes an experienced physician to determine what is going on. Prolapse most commonly involves the bladder, rectum, &/or the uterus or top of the vagina; but the small bowel may also be involved (an "enterocele"). It is important to know what pelvic structures are involved with prolapse in order to determine the best treatment.

Bladder Prolapse- The bladder normally sits above the vagina. When the tissues which support the bladder are damaged, the bladder drops into the vagina- this is called a “cystocele.” This loss of support can occur in the middle of the bladder or where the vagina attaches to the sides of the pelvis, or both. This may cause pressure, difficulty with urination, loss of urine with physical stress (“Genuine Stress Incontinence”), & perhaps urinary urgency  & symptoms of Overactive Bladder. Click here for more information about both of these conditions.

This is a diagram showing loss of bladder support.

Rectal Prolapse- The rectum normally sits below your vagina. When the tissues which normally keep the rectum in place below the vagina are damaged, the rectum forms a hernia in the vagina which may make it difficult to empty your bowels. The tissues are damaged by childbirth, & this can be worsened with chronic constipation. This type of bulge is called a “rectocele.” Many women with this problem have to push down in their vagina with their fingers (“splinting”) to empty their rectum.  This problem is commonly associated with damage to the tissues beneath the opening of the vagina (the "perineum") which leads to an increase in the size of the vaginal opening. This may cause difficulty retaining a tampon or decreased sensation with sexual intercourse.

This is a diagram showing loss of rectal support.

Uterine & Vaginal Cuff Prolapse- The uterus is normally attached to ligaments on each side which attach to the sacrum. When these tissues are damaged the uterus will drop into the vagina. When a hysterectomy is performed the surgeon usually tries to attach the upper vagina (vaginal "cuff" or "vault") to the ends of these ligaments to support the upper vagina. The loss of support of the uterus or vaginal cuff may cause pelvic pressure, back pain, &/or discomfort with sex. While it is difficult to envision, the vagina is essentially turning inside-out, much like pushing the toe of a sock inside-out with your finger. The small bowel normally sits above the vagina & will form a hernia called an “enterocele” in this case.

This diagram shows normal support of the upper vagina after hysterectomy.

 This diagram shows loss of support of the upper vagina after hysterectomy.

This diagram shows prolapse of the uterus, bladder, & rectum.

With time, both of these conditions slowly worsen resulting in the tissues being completely outside. The bulge can become the size of a grapefruit & make walking & sitting uncomfortable. This is referred to as "complete" prolapse or "procidentia."

This is a diagram of complete uterine prolapse.

This is a diagram of complete vaginal vault prolapse.

For more information about treatment options for vaginal prolapse click here.