What is Vaginal Prolapse? What Women Need to Know

What is Vaginal Prolapse ?

Vaginal prolapse is a common condition with an estimated one in two women suffering from this condition. This health professional information helps you understand non surgical Physiotherapy techniques to reduce prolapse symptoms and better manage vaginal prolapse.

Read on now to learn: What is vaginal prolapse

  • What is vaginal prolapse?
  • Vaginal prolapse symptoms
  • What causes vaginal prolapse
  • Vaginal prolapse and pregnancy
  • Vaginal prolapse treatment
  • Can pelvic prolapse exercise reverse vaginal prolapse?

Download ‘What is Vaginal Prolapse?’ as a user friendly PDF by scrolling down.

This article is by Pelvic Floor Physiotherapist Michelle Kenway, author of the internationally acclaimed guide Inside Out – the essential women’s guide to pelvic support.

What is Vaginal Prolapse?

Vaginal prolapse is a general term for a bulge or protrusion into the vagina. This occurs when the vaginal walls and supports become thin, weakened and stretched.

There are 3 main types of vaginal prolapse:

  1. Bladder prolapse (cystocele) – when the bladder bulges into the upper front wall of the vagina (shown below)what is vaginal prolapse
  2. Bowel prolapse (rectocele) – when the rectum and or colon bulge into the lower back wall of the vagina (shown below)

    Image of vaginal prolapse

  3. Uterine prolapse – when the upper vagina, cervix and uterus move down into the vagina (shown below)

Image of vaginal prolapse

A vaginal prolapse can involve any one of these types of prolapse and they can also occur in combination with each other for example a woman may be diagnosed with a prolapse of both the front and back walls of the vagina (bladder and rectal prolapse).

Vaginal Prolapse Symptoms

Vaginal prolapse may present with a variety of different symptoms depending upon the type and severity of the prolapse. Some women with mild prolapse are completely unaware of even having a prolapse and have no symptoms.

Vaginal prolapse symptoms include:

  • A bulging feeling at the entrance of the vagina
  • A sensation of a lump coming down in the vaginaWhat is vaginal prolapse
  • Heaviness within the vagina particularly towards the end of the day
  • Constipation or incomplete bowel emptying needing to manually assist bowel empty
  • Bladder problems including slow flow and incomplete emptying
  • Chronic bladder infection
  • Discomfort with sexual intercourse
  • Difficulty inserting tampons
  • Ongoing low back pain.

What Causes Vaginal Prolapse?

There are a number of potential causes of vaginal prolapse and the incidence increases with menopause and increasing age. The following factors all increase the likelihood of pelvic organ prolapse.

  1. Pelvic floor injury during pregnancy and childbirth
  2. Decreased oestrogen levels with menopause
  3. Long-term straining  to empty the bowels with constipation
  4. Chronic coughing associated with smoking and lung disease
  5. Obesity and overweight
  6. Inappropriate exercise that overloads the pelvic floor
  7. Heavy lifting
  8. Ageing and associated thinning of pelvic floor muscles
  9. Previous incontinence and/or prolapse surgery.

What is Vaginal Prolapse Non-Surgical Treatment?

There are a number of strategies used by physiotherapists to treat vaginal prolapse. A pelvic floor physiotherapist will usually assess you individually to identify the specific causes and lifestyle factors associated with your prolapse. Treatment strategies are then often based upon strengthening pelvic floor support and addressing relevant lifestyle factors. Pelvic floor physiotherapy is usually most effective for women with mild to moderate prolapse. Women with severe vaginal prolapse will usually require surgery to alleviate their prolapse symptoms and physiotherapy is often a part of management to prevent prolapse recurrence.

  1. Pelvic exercises are usually at the forefront of non-surgical treatment for prolapsed vagina. This involves prescription of progressive pelvic floor exercises to improve pelvic floor muscle support. Pelvic exercises are often prescribed before and after prolapse surgery in an effort to prevent recurrent prolapse and preserve the repair for as long as possible.
  2. Modification of  lifestyle factors that may be increasing pressure upon the pelvic floor. This can include instruction in bowel management and correct bowel emptying techniques to avoid straining, modification of unsafe exercise practices to pelvic floor safe exercise programs and assistance with pelvic floor safe weight reduction exercises.
  3. Pessary for prolapse support can be an excellent non-surgical option for supporting prolapsed vaginal tissues during pelvic floor rehabilitation and in situations when surgery is not desirable or indicated. A vaginal pessary sits high inside the vagina and is usually fitted by a gynaecologist. Vaginal pessary can provide very useful support for women with pregnancy and childbirth-related prolapse during their recovery.
  4. Medical referral for vaginal oestrogen treatment to improve the condition of oestrogen-deficient vaginal tissues.
  5. Prolapse surgery is usually offered to women with severe prolapse and those women who have ongoing symptoms despite conservative physiotherapy treatment. Vaginal prolapse surgery repairs the vaginal walls and/or vaginal supports within the pelvis. Following prolapse surgery women are usually advised to avoid or modify those lifestyle factors that originally contributed to their prolapse to minimise the risk of recurrence.

Vaginal Prolapse and Pregnancy

Pregnancy is associated with steadily increasing downward pressure onto the pelvic floor as pregnancy progresses and weight increases. Hormones that prepare a woman’s body for childbirth allow the pelvic supports to stretch. The combination of increasing strain on the pelvic floor and decreased support cause the pelvic floor muscles to progressively stretch and weaken.

Vaginal delivery is associated with a large degree of pelvic floor muscle stretching.This has been found to be most commonly associated with prolonged second stage of labour and forceps delivery. Pelvic floor structures can become damaged during the process of vaginal delivery including pelvic floor muscles and the pelvic nerves supplying these muscles. As a result some women experience prolapse immediately after or in the weeks following difficult labour and vaginal delivery. Recovery is possible for some of these women with postnatal healing, pelvic floor muscle recovery and return to normal hormonal status.

Can Pelvic Exercises Reverse Prolapse?

No, pelvic prolapse cannot be reversed by pelvic floor exercises. Prolapsed vaginal walls are like a hernia of the bladder or bowel into these thinned and weakened walls. The only way to repair a hernia is via surgery.

Pelvic exercises can increase the strength, and thickness of the pelvic floor supports in addition elevating the pelvic floor higher within the pelvis. Some women with mild to moderate prolapse find that after 3-5 months of dedicated pelvic exercises, their prolapse symptoms are minimal and/or disappear altogether.

PDF  Download What is Vaginal Prolapse as a user friendly PDF

This article has provided answers to ‘What is vaginal prolapse?’ and discussed conservative prolapse treatment strategies intended to help you understand your options. A diagnosis of vaginal prolapse does not automatically indicate the need for surgery, or that it will necessarily worsen over time. In many cases women are able to manage mild to moderate prolapse symptoms with improved pelvic floor support and simple modification of lifestyle factors.

Inside Out Book and DVD Saver PackABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is a Pelvic Floor Physiotherapist and author of Inside Out – the Essential Women’s Guide to Pelvic Support. The Inside Out exercise DVD and book show women how to strengthen the pelvic floor and exercise effectively with pelvic floor safe exercises.

Comments

  1. Hi, I’m a swedish woman age 35 and mother of two children 2 and 4 years old. I suffered from bladder prolapse after getting birth to my second child. I had surgery for this in May this year. The surgery was successful. I have a few questions about the advice you give to women who suffer from bladder prolapse. The advice are quite different from the ones we get in Sweden. Core exercises like pilates and plank are for example recommended after surgery.

    Before child birth long distance running was one of my favorite things to do. Do you think I will ever be able to run again?

    Thank you! best regards Malin

    • Michelle Kenway says:

      Hi Malin

      Thanks for your enquiry. Yes it is really difficult to know what is safe after bladder prolapse surgery, and I understand you will be seeking to stay active long-term especially in view of your age. I think the key consideration for you is your pelvic floor muscle strength and function, in other words how well it is working as this in part determines what you can do long-term. I think the other consideration is the fact that you have now had prolapse repair surgery, so your risk of repeat prolapse is unfortunately increased down the track so you need to be mindful of the exercises you choose and those you avoid in order to minimise your risk of a repeat prolapse.

      In women who have really good pelvic floor strength and support, these women may be able to perform high impact exercises such as running and intense core abdominal exercises such as Plank. Other women whose pelvic floor muscles are not working well, and whose pelvic support ligaments and tissues are stretched will be less able to withstand the pressure associated with these exercises.

      As far as Pilates exercises go, some are excellent for rehab. and some need to be avoided by some women without a doubt. The gentle core exercises included in some Pilates programs are ideal for many women to incorporate into post op. rehab however the intense Pilates core abdominal exercises are not. These are the exercises where the abdominal core muscles contract very strongly, and they require well functioning and strong pelvic floor muscles to counteract – these are the core abdominal exercises that are not suitable for many women after bladder prolapse surgery. In women with poorly functioning pelvic floor muscles, intense core exercises will force their pelvic floor downwards, and this is not what a woman needs after already having endured prolapse surgery.

      So in summary the post op. prolapse core exercises a woman can and should do depends on the capacity of her pelvic floor muscles versus the downward pressure created by those particular core exercises. It’s a very individual thing, and potentially risky after prolapse surgery, as it is very difficult to know whether your pelvic floor has the strength and function to withstand particular exercises.

      This is a very long answer to your question, but I feel that this is information that may help you to make informed decisions about your exercise program long-term. I do hope this helps you towards staying healthy fit and well Malin.

      Michelle

  2. Hi, i am a 19-year-old woman and have recently started noticing symptoms similar to prolapse, but it doesn’t seem quite like any of the listed types. Thinking back i have already had these symptoms for a while, but they’re quite mild. I have noted slight bulging when using the bathroom, but no difficulty with passing urine or bowel movements. Also, the bulging is not from the direction of the bladder or rectum, but both the left and right side. I also considered they may be some kind of cysts, but they’re very even in size, and painless (though a bit sensitive). Also, i tried feeling the vaginal walls using my fingers and it feels like my cervix is in the right place, though i guess i might be wrong there, because the uterus is easily movable. Is it possible that the vaginal walls are what are bulging, and do you think i shud see a gynecologist just to make sure? These symptoms as they are now do not bother my daily life and the bulging is little and only noticeable when i especially touch it with my fingers. Also, might dysmenorrhea (mestrual pain) and slight pain in the stomach when the bladder is full have any connetion to this?
    Taking my age into consideration (and the fact that i have not given birth) it is difficult to believe that this might be something very serious.
    Thank you in advance.

    • Michelle Kenway says:

      Hi Kate
      Thanks for your question. With any undiagnosed vaginal bulging, see your doctor for an assessment and examination. It is best to be sure about the exact nature of this, then you will know how to manage appropriately no matter how tempting it is to try self diagnose. Best to be certain about whether or not a problem exists and go from there.
      Best of luck
      Michelle

  3. Hi…I am 30 and have a 2 year old son.. I noticed vaginal prolapse
    just after my delivery. I am 5′ 3 and weigh 122 pounds.. I wanted to
    lose weIght and get in good shape.. So I bought brazalian butt lift exercise
    butt squarts are straining my prolapse… Is it possible to get a peserry fit in
    and continue my exercise… I want to reach 110 pounds to feel light..because when I was low in weight .. I hardly felt the prolapse so I wanted good shape to feel fit and
    Support my prolapse
    Please guide me to lose weight with goid butt shaped …
    Thanks shamaila

    • Michelle Kenway says:

      Hi Shamalia
      You are correct in that the lower your abdominal fat, then the less pressure on your pelvic floor and prolapse so weight loss may help you alleviate some pressure and discomfort. Remeber that butt squats won’t make you lose abdominal body fat – yes the may tone your butt but they won’t make you lose any fat from where you need to. To lose abdominal body fat which is the fat in and around your abdominal organs (which sits above and loads down your pelvic floor) you need to focus on whole body weight loss with cardio exercises such as brisk walking, cycling/spinning and diet. You may find this article interesting on high/low intensity exercise that has been shown to be very effective for abdominal body fat loss. Avoid those exercises such as deep squats that strain your prolapse.

      Thanks for commenting
      Cheers
      Michelle

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