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Vaginal prolapse - What is it?

Normally, the pelvic organs are held in position by the pelvic floor muscles and ligaments. Pelvic organ prolapse occurs when the tissues and muscles of the pelvic floor become weak or damaged. This means that the organs around the vagina (eg. the bladder, rectum, small bowel and womb) are not supported properly and can bulge into the vagina, causing discomfort.
 
Although prolapse is rarely a serious health threat, it can cause distress and adversely affect your quality of life
 

What causes vaginal prolapse?

The pelvic floor may become stretched or weakened for a number of reasons, but the commonest are pregnancy and ageing. Possible causes include:
  • Pregnancy and childbirth
  • Ageing and the menopause
  • Obesity
  • Chronic cough or straining (eg constipation, heavy lifting)
  • Previous pelvic surgery
  • Neurological conditions
 

Pregnancy

Pelvic organ prolapse is very common: around half of women who have children will experience some form of prolapse. The weight of the baby during pregnancy followed by the stretching that occurs during labour puts strain on the pelvic floor muscles and ligaments. These tissues may never fully regain their strength and elasticity. The risk of damage is greater if you have a large baby, a long labour or a forceps delivery. The risk also increases with the number of children you have.
 
Most studies suggest that the risk of prolapse is only slightly lower (if at all) with a caesarean section compared with a vaginal delivery.
 

Different types of prolapse

The type of prolapse can vary depending on which organ is affected and therefore where the bulge is. Some patients have prolapse of more than one organ.
 
There are a number of different types of prolapse:
 

Bladder prolapse (cystocoele)

When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall. As well as causing a bulge and discomfort, patients with a cystocele may also have urinary symptoms. These can include overactive bladder symptoms (frequency and urgency of passing urine) or incontinence. Other patients have difficulty emptying the bladder due to their cystocele
 
Occasionally these urinary symptoms may not become apparent until after a cystocele repair, and your consultant may advise specialist bladder tests (urodynamics) prior to any operation to see if this is likely to happen.

 

Prolapse of the small bowel (enterocele)

In this type of prolapse, part of the intestine pushes down causing a bulge near the top of the vagina. This often occurs at the same time as other types of prolapse.
 
 

Prolapse of the womb (uterine prolapse)

This is when the ligaments and muscles that support the uterus (womb) become weakened allowing the womb to drop down into the vagina. It is common to get a prolapse of the bladder or bowel at the same time.
 
 

Prolapse of the rectum (rectocele)

This occurs when the end of the large bowel (rectum) loses support and bulges into the back wall of the vagina. As well as noticing a bulge, some patients have difficulty emptying their bowel and may use a finger inside the vagina to help them to go.