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Vaginal Prolapse

(Pelvic Floor Relaxation)

Definition

Vaginal prolapse is the inward and downward bulging of the vaginal walls. The severity of vaginal prolapse may be defined as:
  • First degree—collapse into the upper part of the vagina
  • Second degree—collapse further into the vaginal canal, down to the level of the vaginal opening
  • Third degree—collapse that extends beyond the opening

Causes

Vaginal prolapse is caused by weakened support structures in the pelvic region. The lack of support causes the walls of the vagina to weaken, sag, and collapse.
Pelvic Floor Muscles and Organs
Pelvic floor muscels
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Risk Factors

Your risk of vaginal prolapse increases with age. Other factors include:

Symptoms

Symptoms may include:
  • Pelvic pressure
  • A feeling of vaginal fullness or heaviness
  • A feeling of pulling in the pelvis
  • Vaginal discomfort
  • Urinary urgency and frequency
  • Urination when laughing, sneezing, coughing, or exercising
  • Constipation
  • Difficult or painful intercourse
  • Low backache that is relieved with lying down

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Vaginal prolapse that has no symptoms may be diagnosed during routine examinations. You may be referred to a gynecologist, who will do a pelvic exam.

Treatment

Talk with your doctor about the best treatment plan for you. First or second degree prolapse without symptoms may not require treatment. Treatment options include:

Kegel Exercises

Kegel exercises involve tensing the muscles around the vagina and anus, holding for several seconds, then releasing. The repetition of this exercise will help to tone pelvic muscles.

Medications

Estrogen therapy may be advised. This may help prevent further weakness of the pelvic floor.

Pessary Insertion

A pessary may be inserted into the upper portion of the vagina. A pessary is a rubbery, doughnut-shaped device. It helps to prop up the uterus and bladder. Pessary placement is more often used in older women.

Surgery

Vaginal prolapse that is severe or associated with lasting symptoms may require surgery. Surgery may involve repairing the pelvic floor structure or, in some cases, to suture the vagina.

Prevention

To help prevent vaginal prolapse:
  • Do Kegel exercises .
  • Maintain a healthy weight.
  • To avoid constipation, eat plenty of fruits, vegetables, and whole grains. Drink plenty of fluids throughout the day.
  • If you smoke, talk to your doctor about ways to quit . Smoking may cause chronic coughing and weakening of connective tissues.
  • Limit heavy lifting.

RESOURCES

American Congress of Obstetricians and Gynecologists http://www.acog.org

US Department of Health and Human Services Women's Health http://www.womenshealth.gov

CANADIAN RESOURCES

Canadian Women's Health Network http://www.cwhn.ca

Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

References

Pelvic organ prolapse. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 10, 2014. Accessed March 18, 2014.

Pelvic organ prolapse. International Urogynecological Association website. Available at: http://www.iuga.org/resource/resmgr/Brochures/eng%5Fpop.pdf. Published 2011. Accessed March 18, 2014.

Pelvic relaxation syndromes. Merck Manual for Health Care Professionals. Available at: http://www.merckmanuals.com/professional/gynecology%5Fand%5Fobstetrics/pelvic%5Frelaxation%5Fsyndromes/overview%5Fof%5Fpelvic%5Frelaxation%5Fsyndromes.html. Updated December 2013. Accessed March 18, 2014.

5/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Fritel X, Varnoux N, Zins M, Breart G, Ringa V. Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors. Obstet Gynecol. 2009;113:609-616.

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