Vaginal prolapse is a lack of support for the pelvic structures (uterus, intestines, bladder and/or rectum) that results in a hernia or bulging of these organs into the vagina. Women with this problem often have the sensation of pressure in the pelvis or “something falling out of me.” In more extreme cases, the prolapse is outside the vagina and will block the flow of urine and or bowel movements. The condition is usually painless but can cause discomfort. The symptoms tend to worsen as the day progresses, the longer you are on your feet.
This condition has various degrees of progression. It is a quality of life condition. Vaginal and uterine prolapse can be caused by the following factors:
- Straining from chronic conditions such as constipation or excessive coughing
- Frequently lifting heavy objects
- Pelvic muscle weakening
- Genetic factors
There are both surgical and non-surgical ways to treat pelvic organ prolapse. The key to proper management of your prolapse is a detailed evaluation.
Evaluation of Prolapse:
There are multiple portions of the vagina that can be involved in prolapse. It is important to determine which portion of the vagina, which and to what degree underlying organs (bladder, rectum, uterus, intestines) are involved in your prolapse. In some cases, prolapse does not cause any symptoms. When prolapse is bothersome, it is very important to determine what portion of your prolapse is causing your particular symptoms and most importantly that you see a Board Certified Urogynecologist who has expertise in both urological and gynecological procedures.
Traditionally surgery is performed either through the abdomen or the vagina and may involve a hysterectomy. Vaginal procedures are most commonly performed. Vaginal repairs traditionally incorporated various plication procedures using the patient’s native tissues. These techniques relied upon the hope that the scarring from the surgical repair would be adequate to hold the prolapsed segment(s) of the vagina in place. Unfortunately the failure rate was high. Advances in the surgical management of prolapse have incorporated the use of biological and or synthetic grafts to augment the patient’s deficient tissues. Many new surgical devices have facilitated the use of graft augmentation. Your doctor will help you decide which procedure is appropriate for you, based on your symptoms and medical history.
Not all doctors have the same training and experience to address surgical urogynecology procedures. Dr. Jason Thompson is both board certified in Obstetrics & Gynecology and board certified in Female Pelvic Medicine & Reconstructive Surgery. When surgery is the best approach, your best chance for long-term success is with your initial procedure. It is important to seek expert evaluation from the start.
Pessary – The pessary is the mainstay of non-surgical management of prolapse. A pessary is a silicone vaginal insert that is inserted into the vagina to provide support to the pelvic organ. Pessaries are available in many sizes and shapes. These ring-like objects are fitted in your doctor’s office and can easily be inserted and removed at your convenience. With a properly fit pessary, you won’t even know it’s there.
Pelvic floor exercises (Kegel exercises) / Pelvic Floor Rehab – These exercises help to strengthen the pelvic floor musculature. These exercises will not reverse prolapse but may prevent or at least slow down its progression.