Vaginal prolapse refers to an outward protrusion of the vagina. It is also called vaginal prolapse and is medically a fourth-degree vaginal prolapse.
What is vaginal prolapse?
Schematic diagram showing the anatomy and structure of the uterus in uterine prolapse. However, in vaginal prolapse, the uterus protrudes further outward. Click to enlarge. Vaginal prolapse is the outward protrusion of the vagina. At a minimum, there is a more or less visible leakage of the vaginal mucosa. This discharge can be seen in the genital area of the woman. Thus, the vagina protrudes from the body and thus enters between the labia. Furthermore, the vaginal prolapse can be extended by the exit of other organs. These organs then occupy the space previously held by the vagina. Whether this happens depends, among other things, on which part of the vagina is leaking. For example, the cervix (less commonly the uterus), urethra, and bladder may also be affected. Less commonly, the posterior vaginal wall also leaks, which can lead to rectal involvement. Vaginal prolapse can further be subdivided, and the extent must be determined. Complete vaginal prolapse is termed prolapsus vaginae completus sive totalis, and cervical involvement is termed prolapsus vaginae et cervicis. Partial forms in which the descent of the internal female genital organs does not result in a strongly visible prolapse are accordingly also called prolapsus vaginae incompletus sive partialis. The distinction between vaginal prolapse and vaginal prolapse is relevant for the definition: Vaginal prolapse means a change in the localization of the internal organs, whereas vaginal prolapse explicitly means leakage. Vaginal prolapse has four degrees of severity and vaginal prolapse is the fourth degree of vaginal prolapse. In the other three degrees, there is no organ leakage. In this context, involvement of the urinary bladder is called cystocele, involvement of the urethra is called urethrocystocele and involvement of the intestine is called rectocele. In most cases, this is tied to the degree of vaginal prolapse. If the lower third is involved, urethrocystocele is almost inevitable. In two-thirds, the cystocele follows, and if the posterior vaginal wall has become detached, a rectocele may result. The corresponding organs then enter the unused space and sometimes additionally displace the components of the vagina.
Causes
The causes of vaginal prolapse are rooted in the holding apparatus of the vagina as well as the stresses a woman experiences. The holding apparatus itself, which is largely made up of ligaments and muscles, is stressed over the years. Each birth presents a special challenge, especially with large children and multiple births. Accordingly, a vagina rarely recovers completely from a birth process, but is still functional. Rarely is a single birth the cause of vaginal prolapse. Rather, vaginal births can vary widely – depending on the health, age and body type of the woman giving birth. In some cases, injury occurs in the vagina itself and in the holding apparatus due to overstretching. The so-called maternal ligaments are particularly stressed during childbirth. Menopause and aging also play a role. For example, the holding apparatus loses elasticity due to aging and can promote changes in the position of the internal organs accordingly. Almost every woman beyond menopause also has a slight vaginal droop. This is considered normal. Lifestyle is strongly responsible for the health of the vaginal structures. For example, being overweight has a counterproductive effect due to the constantly increased pressure. The same is true of chronic constipation and frequent, severe coughing. Improper lifting of heavy loads is also a risk factor for the occurrence of prolapses of all kinds. Removal of the uterus (hysterectomy) can also lead to vaginal prolapse, insofar as the resulting vaginal blind sac is not adequately secured. It may find its way downward due to gravity and leak out. Overall, it is common for vaginal prolapse to develop gradually and for the vaginal leakage to be triggered by a single event and thus become visible.
Symptoms, complaints and signs
Signs of an approaching vaginal prolapse are sometimes difficult to detect, as freedom from symptoms is the norm until the actual prolapse occurs. However, at times, changes in the vagina can already be detected by visual inspection. The vaginal prolapse itself causes few symptoms. There may be a foreign body sensation in the vagina. Most women experience a sensation of pressure or traction that seems to reach downward. In addition, there is back pain that may worsen throughout the day. Severe pain, however, is rare in this context. The vaginal prolapse is also visible, at the latest after a slight spreading of the labia. In addition, if the bladder and rectum are involved, there are also corresponding symptoms in this area. A urethrocele with cystocele may lead to incontinence, whereas an extensive cystocele may lead to urinary retention, and a rectocele may interfere with defecation.
Complications
Complications associated with vaginal prolapse arise primarily from the organs involved. Thus, at times, there is no longer the possibility of reversing the vaginal prolapse without surgical intervention. This involves the usual risks of surgery. In this context, the uterus is often removed, which prevents fertility by natural means. At most, a possible urinary retention can become dangerous. This can affect the kidneys after a certain time, which can ultimately lead to life-threatening sepsis if the bladder is not relieved.
When should you go to the doctor?
A vaginal prolapse will usually move affected women to the doctor quickly. The severe change in the sexual organs can be felt and seen. In addition, vaginal prolapse is usually not easy to correct manually by the affected woman herself. A visit to the gynecologist is advised in this case. If urinary retention has occurred, an emergency ward should also be visited so that the bladder can be relieved quickly and the kidneys are not affected. Overall, any vaginal prolapse is worthy of evaluation and treatment. While such vaginal prolapse occasionally occurs in some animal species and is self-reversing, this is rarely the case in humans.
Diagnosis
Diagnosis is made primarily by external examination of the vagina. In doing so, the physician can determine fairly quickly whether the problem is a whole vaginal prolapse or a persistent vaginal prolapse. Vaginal prolapse is easier to recognize. Once the diagnosis in this regard is established, the lower abdomen is also checked (for example, by ultrasound) to check for possible displacement of other organs. Part of the diagnosis also consists of a medical history, in which the patient and physician review moments that may have led to the prolapse. This is relevant in identifying the exact cause of the vaginal prolapse. From this, specific instructions for action are given for follow-up care after treatment.
Treatment and therapy
Treatment of vaginal prolapse consists of acute treatment and follow-up care. Acute treatment aims to return the vagina to its original state. Surgical and non-surgical procedures can be considered. The non-surgical procedure essentially consists of using pessaries. These objects are inserted into the vagina and serve primarily to support the uterus. Thus, they are mainly used when the uterus has passed through the vagina to the outside. A pessary can be made of different materials and have very different shapes. It is intended for long-term use. Otherwise, there are surgical procedures, all of which are considered uncomplicated. This can involve tightening the vagina (on the front or back wall), often surgically altering or removing the cervix. This procedure is often used for common vaginal prolapse. If the uterus is also fully or partially involved, a hysterectomy is preferable. If organs have invaded the resulting space due to the prolapse, they are manually repositioned. Sometimes it is necessary to fix the organs, which is often done through small incisions through the abdominal wall.Aftercare consists mainly of pelvic floor muscle training and avoiding certain activities.
Outlook and prognosis
The prognosis for vaginal prolapse is considered favorable. Surgically, almost all prolapses of this type can be satisfactorily repaired. Sometimes the insertion of a pessary is also sufficient. The women who underwent vaginal prolapse do not have to fear any limitations regarding the sensations in the sexual area. Vaginal prolapse also has no effect on childbirth and pregnancy, as long as the uterus is not removed. However, it should be noted that a woman can experience more than one vaginal prolapse. This depends a lot on the integrity of her internal support system.
Prevention
Vaginal prolapse can be prevented indirectly. The measures listed here are designed to maintain the health of the vagina and the structures that support it. In this regard, it makes sense to simply not do certain things at all or to do them infrequently. For example, when lifting heavy loads, do not lift from the back, but from the knees. It results in a straighter back with this lifting technique, which means less pressure on the vagina. Endurance sports, such as swimming or cycling, help overall to strengthen the internal and external muscles. Pelvic floor muscle training, however, is the best preventive measure. Here, targeted action can be taken on the retention behavior and the feeling of tension in the vaginal area. Not only does this increase awareness and self-control: The holding apparatus of the vagina is also strengthened through this. Pelvic floor muscle training is a preventive measure as well as an aftercare measure. Excess weight should also be reduced. Those who have already experienced vaginal prolapse should refrain from excessive training of the abdominal muscles. This can increase the pressure on the vagina under unfavorable circumstances.
Aftercare
After surgery is performed, it is advisable for patients to avoid lifting heavy weights. In addition, it is advisable to strengthen the pelvic floor muscles in the long term by continuous pelvic floor training. This has a targeted effect on the holding behavior and tension in the vaginal area. Ideally, pelvic floor training should be learned correctly under physiotherapeutic guidance and practiced daily. Thus, it is both a preventive and an aftercare measure. In addition, regular exercise, such as cycling or swimming, is helpful in improving general physical fitness and preventing a recurrence of vaginal prolapse. However, excessive exercise of the abdominal muscles should be avoided, as this may increase the pressure on the vagina. Since severe obesity, chronic constipation and chronic coughing also pose risks, these factors should be counteracted as part of follow-up care. A successfully treated vaginal prolapse usually does not result in further health consequences. Unless the uterus has been removed, it has no effect on further pregnancies and births. Sexual life is also not normally restricted after the healing phase is complete. However, lack of follow-up care increases the risk of suffering another vaginal prolapse.
What you can do yourself
In the case of vaginal prolapse, there are few self-help options that can bring about a change in visual appearance. Close collaboration with a physician is therefore necessary in this disorder. Various techniques can be used to manage the condition, which provide an improvement in general well-being. Specific training of the muscles in the pelvic floor area can help to tighten the muscles and thereby relieve the symptoms. The abdominal wall tightens through certain regularly performed training sessions and improves the health of the affected person. The exercises can be learned and performed on one’s own or together in a physiotherapeutic treatment. If a surgical procedure is performed, sufficient rest should be taken. In addition, a balanced diet is recommended for optimal wound healing. Sexual practices should be adapted to the needs of the organism. However, a complete renunciation of physical closeness is not advisable, since according to studies this basically supports well-being and quality of life.To avoid complications and side effects, the use of non-prescribed medications to relieve pain should be avoided. Cognitive training can help to cope with the pain, as well as the use of various natural remedies. Providing adequate heat to the abdomen provides many sufferers with a reduction in the discomfort experienced.
