Vaginal prolapse is the inward and downward bulging of the vaginal walls. It occurs when the supporting tissues of the lower pelvis weaken. The lack of support causes the walls of the vagina walls to weaken, sag, and collapse. Prolapse may also occur after hysterectomy . Other structures or organs near the vagina are also shifted. Types of vaginal prolapse include:

• Cystocele (dropped bladder)—when the collapse involves the front of the vagina and bladder
• Rectocele —when the collapse involves the back of the vagina and rectum
• Enterocele—when the collapse involves the top vaginal wall and small bowel

The severity of vaginal prolapse may be simply defined as:

• First degree—collapse into the upper part of the vagina
• Second degree—collapse further into the vaginal canal, down to the level of the vaginal opening
• Third degree—collapse that extends beyond the opening

There are more sophisticated ways of measuring and describing prolapses.

Vaginal prolapse is caused by weakened support structures in the pelvic region. Support tissue includes fascia (a fibrous tissue), ligaments, and muscles.

The following factors increase your chance of developing vaginal prolapse:

• Having multiple vaginal deliveries
• Having a prolonged labor
• Giving birth to a large baby
• Being post- menopausal
• Being of advanced age
• Being overweight
• Having a chronic cough
• Smoking
• Having chronic constipation

Vaginal prolapse may not cause any symptoms. But when it does, the symptoms may include:

• Vaginal pressure
• A feeling of vaginal fullness or heaviness
• A feeling of pulling in the pelvis
• Discomfort in the vagina
• Low backache that is relieved with lying down
• Urinary frequency
• Urination when laughing, sneezing, coughing, or exercising
• Difficulty with bowel movements
• Difficult or painful intercourse

Your doctor will ask about your symptoms and medical history, and do a physical exam. Vaginal prolapse that has no symptoms may be diagnosed during routine gynecologic examinations. Your doctor may refer you to a gynecologist, who will do a pelvic exam.

Talk with your doctor about the best treatment plan for you. First or second degree prolapse without symptoms may not require treatment. Treatment options include:

Kegel exercises consist of a conscious effort to ‘squeeze’ the pelvic muscles. It should feel like you were trying to prevent urination. Each ‘squeeze’ (contraction) of the muscles should be held for 10 seconds, and then relaxed. Repeat a total of ten times for each exercise period. The entire routine should be repeated four times per day.

Your doctor may insert a pessary into the upper portion of the vagina. A pessary is a rubbery, doughnut-shaped device. It helps to prop up the uterus and bladder. Pessary placement is more often employed in older women.

Vaginal prolapse that is severe or associated with lasting symptoms may require surgery. Surgery, called pelvic reconstruction, usually includes colporrhaphy and perhaps hysterectomy . Colporrhaphy is the surgical repair of the pelvic support structures. The top vagina may also be sutured to a stable structure to suspend it.

If you are diagnosed with vaginal prolapse, follow your doctor's instructions .

To help prevent vaginal prolapse:

• Do Kegel exercises regularly, especially before and after childbirth.
• Avoid constipation.
• Maintain a healthy weight.
• If you smoke, quit . Smoking may cause chronic coughing and weakening of connective tissues.
• Limit heavy lifting.
• Avoid birth canal trauma at childbirth.

Last Reviewed December 2011