Prolapse is the stretching of an organ down into or out of the vagina. Organs that can drop from their normal position include the bladder, uterus and rectum. The top of the vagina itself also can collapse into the lower part.
Prolapse is exceptionally common. A large population study published in the medical journal Obstetrics and Gynecology estimated 64 percent of women experience some degree of this condition. However, only about 11 percent typically undergo at least one surgery to correct it, according to another study in the same journal.
What causes prolapse?
Prolapse occurs when the muscles and ligaments that usually hold these organs in place are stretched, torn or fractured. This can happen during pregnancy or childbirth. Repetitive heavy lifting, chronic coughing or constipation can contribute. Women may be more likely to experience the condition if other family members have it.
What are the symptoms of prolapse?
- A sensation of falling or dropping in the bladder, rectum, uterus or vagina.
- A feeling of fullness or pressure in the pelvis or vagina.
- A sensation of sitting on something that is not supposed to be there.
- A protrusion through the vaginal opening.
- Difficulty emptying the bladder or bowels.
- Pain in the lower back or abdomen.
- An increase in vaginal discharge.
- Sexual dysfunction, including painful or difficult intercourse.
- Development of other pelvic floor disorders, including urinary or bowel incontinence, overactive bladder and recurrent bladder infection.
Prolapse can be worse at some times than others. For instance, symptoms are usually more pronounced after strenuous activity or straining for constipation. Gravity and pressure also tend to make prolapse worse at the end of the day. Laying down or resting usually make symptoms less noticeable.
How is prolapse diagnosed?
A physician performs a physical examination with special attention to the pelvis and vagina. Patients will strain, cough or bear down throughout this exam so the doctor can see the prolapse. Patients also might stand and bear down, because prolapse is sometimes visible only in the upright position. In rare circumstances, X-rays may be used.
How is prolapse treated?
There are generally four options:
- Do nothing. Prolapse is not a surgical emergency. Life-threatening complications are rare. Patients can make their own treatment decisions based on the severity of their condition.
- Strengthen the pelvic-floor muscles. We can teach patients exercises to strengthen these muscles. In mild cases, this can prevent vaginal prolapse from getting worse. Learning the correct techniques can help maximize results.
- Insert a pessary. A pessary is a plastic brace that holds a prolapsed vagina in place, improving symptoms. A physician can insert it into the vagina during an office visit. This is a long-term, non-surgical treatment. It also can be a short-term solution to alleviate symptoms until a patient can schedule surgery.
- Surgery. This option can correct the prolapse. The surgical approach, however, will depend on many factors. Patients are actively involved in helping the doctor decide how to operate. Options include making an abdominal incision, using laparoscopic instruments to reduce the size of an abdominal incision or operating through the vagina. Surgery also can involve reconstructing the patient’s own tissue or using graft material to strengthen the repair.
Christiana Care Center for Urogynecology and Pelvic Surgery
Medical Arts Pavilion 2
4735 Ogletown-Stanton Road, Suite 1208, Newark, DE 19713 directions
Christiana Care Concord Health Center
161 Wilmington-West Chester Pike, Chadds Ford, PA 19317 directions
610-361-1030, option 9
Smyrna Health & Wellness Center
100 S. Main Street, Suite 215
Smyrna, DE 19977 directions
501 West 14th Street
Gateway Building, 2nd Floor
Wilmington, DE 19801