What Is Vaginal Prolapse?

Definition

Vaginal prolapse (or pelvic organ prolapse) is a common issue that occurs when the muscles in the pelvis weaken and pelvic organs herniate (or bulge) into the vagina. The uterus, cervix, bladder, or rectum can shift and fall into the vaginal area. This can cause many symptoms, including pain, incontinence, or a protrusion of organs through the vagina.

The pelvic floor is made up of many muscles that work together to support the abdomen and pelvis. These pelvic floor muscles are often thought of as a “hammock,” which cradles and supports these organs. When the pelvic floor muscles weaken or become damaged, the pelvic organs don’t have the support they need.

Prolapse is common, affecting 3% to 6% of women, though many more are found to have prolapse when examined. But they may not have symptoms or may not bring it to medical attention. A large study by the Women’s Health Initiative showed a pelvic organ prolapse prevalence of over 40% in women over 60.

Vaginal prolapse can have impacts on quality of life, body image, sexual function, and the ability to exercise. Prevalence of pelvic organ prolapse is increasing along with the aging population.

Keeping the Pelvic Floor Healthy Before, During, and After Menopause

Written by Camille Moreno, DO, NCMP

What are the different types of prolapse?

Prolapse can be categorized based on the location of the weakness and the organ(s) that enter into the vaginal area: 

• Anterior vaginal prolapse: the bladder falls into the vagina (also called a cystocele)

• Posterior vaginal prolapse: the rectum falls into the vagina (also called rectocele)

• Uterine prolapse: the uterus enters the vaginal area

• Enterocele: the intestine enters the vaginal area

There can also be prolapse of the cervix or parts of the vaginal wall. Or there may be a combination of any of these. 

What causes vaginal prolapse?

Vaginal prolapse can occur anytime there is pressure on the muscles in the pelvis. This is usually caused by a combination of weakening pelvic muscles and tissues, as well as nerve injury — such as from childbirth.

There are some known risk factors for prolapse, which include:

• Pregnancy and vaginal birth: Among women who have given birth, prolapse is due to pregnancy and childbirth 75% of the time.

• Increasing age: As women increase in age and enter menopause, risk of prolapse increases.

• Overweight or obesity: Having obesity increases risk of prolapse by about 50%.

• Chronic constipation: This can increase pressure in the abdomen and increase prolapse risk. 

• Family history: There’s likely a genetic component.

• Connective tissue conditions (such as Ehlers-Danlos): These conditions may weaken muscles and ligaments.

What are symptoms of vaginal prolapse?

Vaginal prolapse can cause a range of symptoms. In some people, it may not cause any symptoms or require any treatment. But in others, prolapse may cause very significant symptoms that impact quality of life, activity level, and relationship intimacy. 

Symptoms or prolapse can include: 

• A bulge or feeling of pressure in the vagina or pelvic area

• Urinary symptoms such as urinary frequency, leaking urine (incontinence), or frequent urinary tract infections

• Constipation or difficulty emptying the bowels — and possibly a need to provide support and pressure to the area in order to have a bowel movement (“splinting”)

• Vaginal irritation and spotting

• Pain with intercourse

Symptoms will depend on the organs and the vaginal area that are affected. Symptoms may get better or worse depending on the time of day and activity level. 

How is vaginal prolapse diagnosed?

Vaginal prolapse will be diagnosed by a healthcare provider after talking about your symptoms and doing a physical exam — including a pelvic exam. Prolapse may also be diagnosed during a routine physical exam such as a Pap smear. Your healthcare provider may ask you to bear down (like you’re having a bowel movement) or tighten your pelvic muscles (like you’re trying to stop a stream of urine).

Prolapse will be categorized by stage, ranging from stage 1 (mild) to 4 (severe). There may be some additional tests to help evaluate bladder or bowel function, including bladder function tests or imaging of the pelvis. It’s important to rule out other conditions that cause similar symptoms, such as a pelvic mass.

How is vaginal prolapse treated?

Treatment for vaginal prolapse will depend on the type of prolapse you have and the severity of your symptoms. Treatment may include:

• Observation: If you’re asymptomatic or have mild prolapse, observation may be the best option. It can include lifestyle changes such as exercise and weight loss, in addition to avoiding smoking, constipation, and heavy lifting.

• Pelvic floor exercises: These may include kegel exercises or methods such as conscious contraction, electrical stimulation, and biofeedback.

• Devices: Devices that are inserted into the vagina — such as a pessary — can provide support to the pelvic organs and keep them in their anatomical place. 

• Surgical treatment: Surgery can strengthen or repair the pelvic floor muscles.

While there are no medications that treat prolapse, there may be some medications that can help with symptoms related to it, such as pain or urinary symptoms. Talk with your healthcare provider about which treatments may be right for you.

Can you prevent vaginal prolapse?

While many of the causes of vaginal prolapse are not things you can control, there may be some steps you can take to prevent vaginal prolapse or prevent it from worsening. For instance, you can:

• Do kegel or pelvic floor exercises at home

• Have a healthy weight

• Have soft, regular stools (avoid being constipated)

• Be careful when lifting heavy items