Vaginal prolapse

What is vaginal prolapse? Occurring when a woman’s pelvic floor muscles, tissues and ligaments weaken and stretch – during childbirth, for example – pelvic organ prolapse can result in organs moving out of their normal position in your body.

Vaginal prolapse happens when the top of your vagina sags and therefore drops into the vaginal canal. A prolapse like this can mean your vagina can often protrude outside of your body – and while it is not life-threatening, this can be an extremely distressing occurrence for anyone who experiences it.

That being said, there are treatment options for those suffering from vaginal prolapse.

Causing pain and discomfort, symptoms of vaginal prolapse can usually be greatly improved with:

• Regular pelvic floor exercises
• Lifestyle changes
• Medical treatment

Vaginal prolapse is more common than you think. David J Griffiths, one of our consultant gynaecologists, says risk of prolapse to the vagina increases in women who have vaginal deliveries during childbirth, and those who have heavy manual jobs.

David says: “One in two ladies who have had a vaginal delivery will exhibit some degree of a prolapse (vaginal bulge).”

“The risk is also increased with the menopause and for those with long history of constipation or connective tissue disorders. For example, patients with hypermobility,” he continues.

If you have a vaginal prolapse, your symptoms may include:

• A throbbing pain in the vagina
• A feeling of fullness in the vagina (a sensation that something is stuck inside the vagina) and/or a feeling that something is ‘falling out’ of the vagina
• Difficulty using tampons
• Pain or discomfort when having sex
• Changes in bladder or bowel function.

While there are no direct causes of a vaginal prolapse, women are at increased risk of developing the condition if they have delivered children vaginally. They are especially prone to a prolapse of the vagina if they have experienced multiple vaginal births.

Women who are approaching menopause may also be more at risk of a vaginal prolapse, and lifestyle factors such as being overweight can also be to blame for the condition.

People who were born with bladder exstrophy – a rare condition whereby the bladder does not form into its normal, round shape and is flattened and exposed on the abdominal wall – may also be more prone to vaginal prolapse.

Women who have undergone surgery to remove their womb (hysterectomy) could be more likely to experience a prolapse of the vagina as well. This is referred to as ‘vaginal prolapse after hysterectomy’.

Whatever the cause for a vaginal prolapse, though, the condition is treatable. In the first instance, you should visit your GP who will be able to assess the cause of your symptoms.

If you are experiencing any of the symptoms of vaginal prolapse, make an appointment with your GP – especially if you have recently given birth and believe prolapse of the vagina could be to blame.

Urgent advice: when to get help from 111

Your GP should be your first port of call if you are experiencing the symptoms of vaginal prolapse. If you have any of the following symptoms, though, 111 may be able to offer you some advice:

• Stinging or burning when you wee or needing to wee more often (this could be the sign of a urine infection)
• Heavy, fresh or smelly vaginal bleeding
• The above symptoms, accompanied by a fever
• Increasing pain in the tummy, with a temperature
• Not wanting to eat and being sick

Just call 111 on your phone if you are experiencing any of the above.

While you may be managing your symptoms well, it’s important to see your GP if you suspect you may be suffering from vaginal prolapse.

Do not feel embarrassed about visiting the GP surgery. Your GP will see people with your symptoms on a regular basis. During the appointment, he or she will review your medical and surgical history and complete a physical exam.

Additional tests may be required, too (including an ultrasound or MRI), but this is a rare occurrence.

Urodynamics testing – a group of tests which evaluate bladder function – may also be recommended by your doctor.

Your GP or another health specialist may refer you to our team here at Circle Health Group, with the view to discussing your long-term options with regard to prolapse.

A full history and clinical examination will be performed, says our Consultant Gynaecologist, David.

“Patients will be asked to ‘bear down’ and they will also be examined on their side, as this is similar to examining someone standing up but easier for the doctor.”

“Often, we will reassure the patient that nothing serious is going on, continues David. “Most patients just want reassurance when they find a lump.”

Treatment for prolapse then includes avoidance of constipation, heavy lifting and straining. “Physio can sometimes help, and some ladies use an internal support, e.g. a pessary, while others decide on surgery.”

For those who have been diagnosed with vaginal prolapse, there are several treatment options. Some people do not need medical treatment, especially if their symptoms are non-existent or if the prolapse is mild.

Some lifestyle changes will always be useful, though – both for people with no symptoms and those with multiple signs of prolapse.

You should avoid heavy lifting; lose weight if you are overweight, and eat a healthy diet to prevent constipation. After all, constipation can lead to straining, which may aggravate a prolapse even further.

If your pelvic organ prolapse is more severe, your GP may speak to you about Kegel exercises (also known as pelvic floor exercises). By doing these, you can begin to strengthen your pelvic floor muscles, which may mean your symptoms improve drastically.

Vaginal pessaries – a silicone or rubber device inserted into the vagina – may also be used to support the vaginal walls and pelvic organs. Ideal if you want to avoid surgery, these can be used to treat moderate to severe vaginal prolapse.

Hormone treatment can also ease some of the symptoms patients experience, including discomfort during sex. This involves using oestrogen to help combat your symptoms.

Surgical repair may be a last resort – and there are a few surgical interventions to consider, depending on the severity of your case.

Vaginal mesh surgery uses a piece of mesh, which is inserted to hold the pelvic organs in place. It is a well-tolerated procedure, which is usually performed using general anaesthetic, but complications may arise in some patients. These include nerve damage, pain, incontinence, sexual problems, and constipation.

A surgical procedure to repair pelvic organ prolapse, a colporrhaphy, also known as vaginal wall repair, corrects defects in the vaginal wall. Restoring organs back to their normal position, it can greatly reduce patients’ symptoms to ensure they can live as normal a life as possible.

Performed under general or local anaesthetic, the procedure sees our consultant insert a speculum into the vagina to hold it open. An incision is then made to separate the skin of the fascia from the lesion, which is then folded over and stitched into place.

Are you wondering: ‘what are the risks of colporrhaphy’? As with all surgical options, the procedure does not come without risk. These include bleeding and infection, recurrent prolapse, injury to other pelvic structures, complications with anaesthesia, and urine leakage.

For some patients, a hysterectomy may be an option. Helping relieve the pressure on the walls of the vagina, the womb is removed – but this is generally only an option for those women who have been through the menopause and therefore do not intend to have any more children.

Those with severe vaginal prolapse may opt for a treatment where the vagina is ‘sewn shut’. ‘Closing the vagina’ is only offered when other treatments have not worked.

How much does vaginal prolapse treatment cost? This depends on the treatment you undergo and the severity of your condition – and patients can find out more about each procedure.

You may choose to pay for your own treatment (you can spread the cost using our flexible payment options) or use your medical insurance.

Some conditions may mimic the symptoms of pressure you would experience with a vaginal prolapse.

These include:

• Urogenital atrophy
• Severe irritation of the vaginal mucosa from a Candida or bacterial source
• A large urethral diverticulum or vaginal wall cyst.

A physical examination is important, therefore, to determine if you are suffering from a prolapse or something else.

Have a question or two about vaginal prolapse? We’ve answered some of your most asked queries below.

Does a prolapse always involve the vagina?

No, a pelvic organ prolapse could involve the womb (uterus), bowel or bladder.

Can a vaginal prolapse cause wind?

Yes, in some cases, abdominal bloating and/or the involuntary passing of wind can be an issue for women who have a vaginal prolapse. When the prolapse is treated or managed, this symptom may improve too.

Can sex cause vaginal prolapse?

No, sexual intercourse will not cause a vaginal prolapse.

Can you have kids after a vaginal prolapse?

Pregnancy is still possible, even if you have a vaginal prolapse – but an elective caesarean section may be the safest form of delivery.

When visiting Circle Health Group for your consultation, it’s important to ask the consultant any questions, such as this one, to help you better understand vaginal prolapse, how it affects you and the available surgical procedures and/or lifestyle modifications.

Can vaginal prolapse cause frequent urination?

Yes, the urge to pass urine may be one symptom of a vaginal prolapse.

Do vaginal prolapse hinder sexual intercourse?

No. There is no risk of aggravating your vaginal prolapse by having sexual intercourse. Again, if you have any questions or concerns, your Consultant Gynaecologist here at Circle Health Group will be happy to answer any of your queries.

Can you see vaginal prolapse?

Yes, the pressure from a prolapse of the vagina can cause a bulge, which may sometimes be felt or seen.

How can I naturally strengthen the vaginal wall to heal a prolapse?

Pelvic floor muscle exercises (also known as Kegel exercises) are a great, natural way to repair the vaginal wall.

How do you do Kegel exercises? Sit on the toilet and go through the motions like you’re going to wee. Instead of letting it out though, squeeze your muscles to stop the urine midstream. Do this for five seconds multiple times a day.

You don’t have to be on the toilet to try the exercises, though; you can squeeze and release the muscles anytime and anywhere.

Does vaginal prolapse cause leg pain?

You may have pain in the lower back, lower belly or groin, as well as leg fatigue, if you have a vaginal prolapse. Pain during sex is another symptom you may experience, alongside the feeling of pressure in your vagina.

Does vaginal prolapse cause discharge?

Yes, you may notice blood-stained or smelly discharge if you have a vaginal prolapse, although not everyone experiences this symptom.

• _{Pelvic organ prolapse - NHS (www.nhs.uk)}
• _{NHS 111 Wales - Health A-Z : Pelvic organ prolapse}
• _{Vaginal Prolapse | Johns Hopkins Medicine}
• _{Pelvic Organ Prolapse (POP): What You Need To Know: The Woman’s Center : Female Pelvic Medicine and Reconstructive Surgery (thewomanscenter.com)}
• _{Management-of-Vaginal-Prolapse-January-2018.pdf (mft.nhs.uk)}
• _{file (leicestershospitals.nhs.uk)}