Vaginal Prolapse: Risk factors, Diagnosis, and Treatment

Protrusion of pelvic organs into or out of the vaginal canal is called VAGINAL PROLAPSE. Uterine prolapse can occur along with the prolapse of the anterior or posterior vaginal compartments. There are basically 3 levels of vaginal supports that are described by De Lancey’s classification. Weakening of the muscles or ligaments that support the vagina, lead to the consequent protrusion of uterus, urethra, bladder or rectum into the vagina.

Why does Prolapse occur? 

• Prolapse can be both congenital as well as acquired.
• Congenital prolapse is usually seen in young nulliparous women.

Causes are as mentioned below :

1. 1. Spina bifida occulta
   2. Ehler Danlos syndrome
   3. Marfan’s syndrome

• On the other hand, major causes for acquired prolapse are:

1. 1. Repeated child birth
   2. Menopause
   3. Traumatic deliveries
   4. Faulty birth practices
   5. Precipitate labor
   6. Iatrogenic (vaginal hysterectomy)
   7. Increased intra-abdominal pressure (as in COPD, obesity, constipation etc.)

Vaginal prolapse can be broadly classified into:

• Anterior vaginal prolapse (cystocele, urethrocele or cystourethrocele)- occurs when the bladder droops into the vagina.
• Posterior vaginal prolapse (Enterocele or rectocele) is when the pouch of Douglas or the rectum protrudes into the vagina.
• Apical prolapse (vaginal vault prolapse) is referred to the bulging of cervix or upper part of the vagina.
• Uterine prolapse is when the uterus protrudes into the vagina.

Symptoms: 

• Sensation of fullness in the vagina and heaviness in the pelvis.
• Pain in lower back might be present, that gets better on supporting the back or when lying on it.
• Frequent urge for urination.
• Intercourse may be painful for some.
• Unfinished sensation after stool or urination.
• Increased tendency to bladder infections is seen.

Diagnosis

• Pelvic examination is the initial step towards the diagnosis of prolapse, in which the patient is usually asked to bear down (as if during stool).
• For any issues with urination, urodynamic tests are used for assessing the functioning of your bladder. It usually consists of uroflowmetry and cystometrogram.
• Other than that, ultrasound of pelvis, MRI of the pelvic floor and CT scan of the abdomen/pelvis might also be suggested by the physician.

Treatment

• Anterior colporrhaphy- for repair of cystocele and urethrocele.
• Posterior colpoperineorrhaphy- for repair of lax perineum and rectocele.
• Repair of enterocele- Abdominal repair (Moscowitz repair) or vaginal repair (Mc Call culdoplasty).

Prevention

• There are a lot of ways through which one can try to tighten their pelvic muscles and lessen the risk of prolapse. For example, Kegel exercises can help reinforce the nerves and muscles of the pelvis. Making certain changes in the lifestyle may help, as well.
• In case you’re overweight, attempt to shed a few pounds. Overweight ladies are more prone to suffer from prolapse than the individuals who maintain their weight. Drinking a lot of fluids and eating high-fiber diet works miraculously as well and also helps in avoiding obstruction.
• Try not to lift anything heavy and learn how to lift the correct way – with your legs, not your back or abs.
• Stop smoking as it is associated with higher risk.
• Consult the doctor about any medical problems, like a cough that just would not go away. Cough puts pressure on the pelvic muscles and can aggravate prolapsed of pelvic organs.

Kegel exercises

These can help make the muscles below the uterus, bladder, and bowels (large intestine) even stronger. They can support people of both sexes who have urge incontinence of urine or faeces or both.- A Kegel exercise resembles the process of micturating and then holding it by relaxing and then tightening the muscles that control urine flow. Repeat these Kegel exercises 3 times a day:

1. Ensure your bladder is empty, and then sit or lie down.
2. Tighten the pelvic floor muscles. Hold tight for about 3 to 5 seconds.
3. Now relax the muscles and wait for 3 to 5 seconds.
4. Repeat the exercise 10 times, 3 times a day (morning, evening, and night).

-Improvement is evident after 4- 6 weeks of regular exercise. Continue doing the exercises, but don’t increase the number of repetitions because over exercise can lead to straining while urinating or defecation.

 

Ehlers-Danlos Syndrome

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