Vaginal prolapse is a common condition that occurs when the muscles, skin and ligaments that surround the pelvic floor weaken and ‘fall out of place’. In severe cases, the vaginal tissues can protrude from the body and affect urinary, rectal and sexual functions. It is more common in women who have given birth naturally or are post-menopausal due to the loss of estrogen, which helps to protect the bones and ligaments.
Types of Vaginal Prolapse
There are several types of vaginal prolapse, according to natural health expert Marilyn Glenville:
Prolapsed womb – this is when the ligaments at the top of the vagina weaken causing the womb to slip down into the vagina. It can happen in stages – from first to fourth degree by severity. First degree prolapse is when the womb drops into the upper part of the vagina. Fourth degree prolapse (procidentia) is when it protrudes from the vaginal opening. This is common post-menopause because of falling estrogen levels.
Vaginal prolapse – when the front and rear walls of the vagina are weakened it can slip downwards. This can happen at the same time as a prolapsed womb. Having an oopherectomy can trigger this, as the womb holds the vaginal structures in place.
Prolapsed rectum (Rectocele) – when the rectum (end part of the colon) collapses into the vaginal wall. This can cause constipation when a stool gets caught in the pockets of the rectum where the prolapse has occurred.
Prolapsed bladder (cystocele) – this is when the bladder slips down into the vaginal area. It can cause recurrent urinary tract infections (UTIs) and/or stress incontinence.
Urethral prolapse – when the urethra (bladder tube) drops down into the vagina. This can cause stress incontinence, UTIs, and painful sex.
Causes of Vaginal Prolapse
The pelvic muscles and ligaments are like a hammock that runs from the front of the pelvis to the back. If parts of the tissues (levator ani) become weak and damaged the pelvic floor becomes too pliable – a condition known as ‘pelvic floor relaxation’. This can destabilise all of the pelvic area. Common causes of prolapse include the following:
- Menopause (estrogen keeps the bones and ligaments strong and this dips post-menopause).
- Pregnancy and childbirth – particularly if a woman has had several heavy babies (9IB and over) and if the delivery is protracted and difficult.
- Oopherectomy – when the womb is removed it makes the top of the vagina more vulnerable to prolapse.
- Ageing
- Gravity (prolapse becomes more noticeable as the day goes on)
- Obesity
- Heavy lifting or strenuous work, or excessive exercise
- Tissue and nerve dysfunction
- More rarely, it can be caused by large fibroids
Signs and Symptoms
Not all women will have obvious symptoms of prolapse, particularly if it is mild so it’s wise to have regular gynaecological examinations to catch any problems in their infancy. Women often report a dragging, heavy sensation in the womb, which worsens as the day progresses. This can be relieved temporarily when you lie down. Other symptoms include painful sex (dyspareunia), feeling a lump at the entrance of the vagina or anus, repeated urinary tract infections, and constipation.
Treatments for Vaginal Prolapse
First, the GP will examine you to work out what type of prolapse you have and how severe it is to determine the treatment. Keep a symptom diary and prepare a list of questions. Various tests can be done to diagnose including bladder function, pelvic floor strength, and MRI and ultrasound, which will show what's going on inside the body.
Non-surgical Treatments
It the prolapse is mild a vaginal pessary may be suggested to hold the vagina in place temporarily. This is a ring made of cellulose of vinyl that you put in yourself or with GP assistance. It needs to be changed every so often for hygiene purposes. Kegel exercises will improve overall pelvic tone, and estrogen cream and HRT will strengthen the bones. Physical therapy via electrical stimulation and biofeedback machines will also build up the pelvic muscles and reverse some of the damage that has occurred.
Surgical Treatments
This is typically a hysterectomy to remove the womb, or uterine suspension, which is when the womb is reattached to the pelvic ligaments to hold it in place.
Preventing Prolapse
There is a lot you can do in mid-life to minimise the risk of prolapse and maintain good reproductive health. Regular sex will tone the PC muscle and keep the vagina well-lubricated. Try Kegel exercises: the Kegel8 Ultra is an electronic muscle stimulator that does the hard work for you to stimulate muscle tone internally. Maintain a healthy body weight, avoid smoking, heavy lifting and over-exercising. If you like to run have your gait assessed to make sure your posture is correct and you're not over-straining the pelvis. Up your fibre intake and drink plenty of water to flush out your system and keep your stools soft.
Marilyn Glenville has lots of inspirational health tips and advice in her ebook on vaginal prolapse if you'd like to read further on the topic. She adds an extra perspective as a nutritionist about the benefits of herbs and supplements to tone and strengthen the uterus, which is something the doctor might not be aware of. Adjusting your diet and lifestyle and consulting a herbalist can be useful alongside conventional medicine to treat the whole woman.
Sources
- Emedicine Health: *"Vaginal Prolapse" by George Lazarou, MD, FACOG, Director of Urogynecology and Reconstructive Pelvic Surgery , Jack D Weiler Hospital (accessed 14/04/11).
- The American Urogynecologic Society: *"Treatment to Correct Pelvic Organ Prolapse in Women May Improve Body Image and Sexual Function" (as reported to the Society's 30th Annual Scientific Meeting).
- Medline Plus: *"Uterine Prolapse" (accessed 14/04/11)
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
Nicci Talbot - Nicci Talbot is a journalist and author specialising in sex, health & wellbeing. She edits Rude Magazine, an online resource for better ...
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