Diagnosis
The diagnosis of a vaginal prolapse or prolapsed vagina is usually made by the gynecologist. The gynaecologist can assess the prolapse in a vaginal examination. If there is only a slight lowering, this can be made visible by coughing or pressing the patient. A palpation examination also provides information about the position and extent of the prolapse. In addition, a vaginal ultrasound is performed, as well as examinations of the bladder and rectum to detect possible concomitant symptoms such as bladder or bowel voiding disorders at an early stage.
Associated symptoms
If the vagina sinks to the bottom, a feeling of pressure in the perineal region occurs. A foreign body sensation develops, which is described as “something falls out of the vagina”. Furthermore, there may be a pulling sensation in the lower abdomen or lower back.
Pain is rather rare. If there is a weakness of the anterior vaginal wall, this is often accompanied by a sinking of the bladder, which is called cystocele. The bladder then protrudes into the anterior vaginal wall.
This usually results in incontinence. This manifests itself particularly under stress, for example by coughing or sneezing. Furthermore, voiding disorders and frequent urinary tract infections occur.
If there is a weakness of the posterior vaginal wall, this is often accompanied by a rectocele. In this case the rectum falls forward in the direction of the vagina. This clinical picture is accompanied by defecation disorders with incontinence, a weakness of the sphincter muscle or constipation. Symptoms can be provoked by coughing or pressing.
Therapy
When treating vaginal prolapse or vaginal prolapse, a number of factors must first be taken into account. There is a classification into four degrees of severity, because depending on the intensity, conservative therapy is possible or surgery is appropriate. The patient’s age and concomitant diseases are also relevant.
An operation can involve increased risks for older or pre-diseased women. If there is a desire for children, this must be taken into account in a surgical procedure.If there is only a slight depression, it can be treated with pelvic floor exercises. Local estrogen treatment in the form of ointments can also be helpful.
A pessary is recommended for transitional treatment or in cases of inoperability. This is a ring or cube that is inserted into the vagina by the gynecologist and is intended to support the organs. This method is very well proven to treat the symptoms, but is not a causal therapy.
The first choice therapy is surgery. Surgery is the first choice therapy for vaginal prolapse. The standard procedure is surgery through the vagina.
Typically, the uterus is removed, a tightening of the pelvic floor and the associated ligaments is performed and excess vaginal tissue is removed. The remaining vaginal stump is closed and attached to the sacrum. This prevents it from sinking down again.
If a child is desired, the sagging is only slightly pronounced or if an isolated cysto or rectocele is present, a single pelvic floor plastic surgery can be performed. In recent years, the use of Vicryl or polypropylene nets has also proven to be a good method. If vaginal surgery is not possible, a small incision is made from the abdomen. Which surgical method is the best is decided on the basis of the anatomical conditions, the degree of prolapse and individual risk factors.
