Vaginal prolapse happens when the muscles that support the organs in a woman’s pelvis weaken. This weakening allows the uterus, urethra, bladder, or rectum to droop down into the vagina. If the pelvic floor muscles weaken enough, these organs can even protrude out of the vagina.
There are a few different types of prolapse:
- Anterior vaginal prolapse (cystocele or urethrocele) happens when the bladder falls down into the vagina.
- Posterior vaginal prolapse (rectocele) is when the wall separating the rectum from the vagina weakens. This allows the rectum to bulge into the vagina.
- Uterine prolapse is when the uterus droops down into the vagina.
- Apical prolapse (vaginal vault prolapse) is when the cervix or upper part of the vagina falls down into the vagina.
What are the symptoms?
Often women don’t have any symptoms from vaginal prolapse. If you do have symptoms, your symptoms will depend on the organ that is prolapsed.
Symptoms can include:
- a feeling of fullness in the vagina
- a lump at the opening of the vagina
- a sensation of heaviness or pressure in the pelvis
- a feeling like you’re "sitting on a ball"
- achy pain in your lower back that gets better when you lie down
- a need to urinate more often than usual
- trouble having a complete bowel movement or emptying your bladder
- frequent bladder infections
- abnormal bleeding from the vagina
- leaking of urine when you cough, sneeze, laugh, have sex, or exercise
- pain during sex
What causes it?
A hammock of muscles, called the pelvic floor muscles, supports your pelvic organs. Childbirth can stretch and weaken these muscles, especially if you had a difficult delivery.
Aging and the loss of estrogen during menopause can further weaken these muscles, allowing the pelvic organs to droop down into the vagina.
Other causes of vaginal prolapse include:
- constant coughing from chronic lung disease
- pressure from excess weight
- chronic constipation
- lifting heavy objects
Are certain women at increased risk?
You’re more likely to have vaginal prolapse if you:
- had vaginal deliveries, especially a complicated one
- have gone through menopause
- are overweight
- cough a lot from lung disease
- are chronically constipated and have to strain to have a bowel movement
- had a family member, such as a mother or sister, with prolapse
- often lift heavy things
- have fibroids
How is it diagnosed?
Vaginal prolapse can be diagnosed through a pelvic exam. During the exam, your doctor might ask you to bear down as if you’re trying to push out a bowel movement.
Your doctor might also ask you to tighten and release the muscles you’d use to stop and start the flow of urine. This test checks the strength of the muscles that support your vagina, uterus, and other pelvic organs.
If you have problems urinating, you may have tests to check your bladder function. This is called urodynamic testing.
- Uroflowmetry measures the amount and strength of your urine stream.
- Cystometrogram determines how full your bladder needs to get before you have to go to the bathroom.
Your doctor might also do one or more of these imaging tests to look for problems with your pelvic organs:
- Pelvic ultrasound. This test uses sound waves to check your bladder and other organs.
- Pelvic floor MRI. This test uses strong magnets and radio waves to make pictures of your pelvic organs.
- CT scan of your abdomen and pelvis. This test uses an X-ray to create detailed pictures of your pelvic organs.
What treatments are available?
Your doctor will recommend the most conservative treatment methods first.
Conservative treatment options
Pelvic floor exercises, also called Kegels, strengthen the muscles that support your vagina, bladder, and other pelvic organs. To do them:
- Squeeze the muscles you’d use to hold in and release urine.
- Hold the contraction for a few seconds, and then let go.
- Do 8 to 10 of these exercises, three times a day.
To help learn where your pelvic floor muscles are, the next time you need to urinate, stop urinating midstream, then start again, and stop. Use this method to learn where the muscles are, it’s not meant to be a continued practice. In future practice, you can do this at times other than urinating. If you can’t find the right muscles, a physical therapist can use biofeedback to help you locate them.
Weight loss may also help. Losing excess weight can take some of the pressure off your bladder or other pelvic organs. Ask your doctor how much weight you need to lose.
Another option is a pessary. This device, which is made from plastic or rubber, goes inside your vagina and holds the bulging tissues in place. It’s easy to learn how to insert a pessary and it helps avoid surgery.
If other methods don’t help, you may want to consider surgery to put the pelvic organs back in place and hold them there. A piece of your own tissue, tissue from a donor, or a man-made material will be used to support the weakened pelvic floor muscles. This surgery can be done through the vagina, or through small incisions (laparoscopically) in your abdomen.
What are the possible complications?
Complications from vaginal prolapse depend on which organs are involved, but they can include:
- sores in the vagina if the uterus or cervix bulges through
- an increased risk for urinary tract infections
- trouble urinating or having bowel movements
- difficulty having sex
What to expect
If you have any symptoms of vaginal prolapse, including a feeling of fullness in your lower belly or a bulge in your vagina, see your gynecologist for an exam. This condition isn’t dangerous, but it can have a negative effect on your quality of life.
Vaginal prolapse is treatable. Milder cases can improve with noninvasive treatments like Kegel exercises and weight loss. For more severe cases, surgery can be effective. However, vaginal prolapse can sometimes come back after surgery.