Genital prolapse occurs when pelvic organs slip out of place, often due to pregnancy, childbirth, or chronic medical conditions. Symptoms vary based on the type of prolapse, but treatments may include pelvic floor exercises, weight loss, pessaries, or surgery.
Genital prolapse, also called pelvic prolapse, is a medical condition in which the organs of the pelvis slip out of their normal positions and fall into the vaginal canal, sometimes protruding from the vagina. This usually impacts women who have experienced pelvic floor weakening or injury due to pregnancy, childbirth, a hysterectomy, a sport that places great strain on the pelvic floor, chronic medical conditions – such as obesity – that put pressure on the belly, or due to genetic predisposition.
Types of genital prolapse include cystocele, which affects the bladder, enterocele, which has to do with prolapse of the small intestine, rectocele, or prolapse of the rectum, uterine prolapse, which occurs when the uterus slips out of place, urethrocele or prolapse of the urethra and vaginal vault prolapse, which occurs when the upper part of the vagina lowers into the vaginal canal. Either of these types of pelvic prolapse can occur independently or with other types of prolapse.
The pelvic floor is a group of muscles and connective tissue that supports the pelvic organs and helps control urination. If it’s damaged, the organs it supports, such as the uterus and bladder, are at risk of slipping out of place and down the vaginal canal. The most common cause of pelvic floor injury is pregnancy and childbirth, although prolapse symptoms may not show until after menopause, when the pelvic floor begins to weaken further due to a drop in estrogen, a female reproductive hormone natural. Other causes, such as pelvic surgery or chronic pressure on the pelvic floor, may also not show symptoms until later in life.
Symptoms vary based on the type of genital prolapse. One of the most telltale signs, however, is a bulge in the vagina or a bulge outside the vagina. In cystocele, in which the support structure between the vaginal wall and the bladder weakens, allowing the bladder to drop, the patient may experience a sensation of pressure in the vagina, pain and urine leakage during sex, difficulty controlling urination , especially when pushing down, such as when coughing, frequent bladder infections, and feeling the need to urinate, even after urinating. A patient with a urethrocele, in which the urethra drops into the vagina, often has no symptoms or mild versions of the symptoms associated with the cystocele.
Enterocele, in which the small intestine slips out of place and falls into the upper part of the vagina, occurs more often in women who have had a hysterectomy. These women may experience abdominal pressure and back pain that eases when lying down, pressure in the vagina, pain during sex, and a bulge in the vagina.
In rectocele, when the tissue supporting the rectum weakens and allows the rectum to push into the vaginal wall, the woman may have some bulging tissue through the vaginal opening and some mild discomfort, but the condition is usually not painful and often occurs without symptoms. Vaginal vault prolapse, a condition in which the upper part of the vagina loses its structural integrity and falls into the vaginal canal, presents with pressure in the pelvis, lower back discomfort, incontinence, vaginal bleeding, and a bulge in the vagina or bulging vaginal opening .
Treatments also vary based on the type and severity of genital prolapse. In some cases, pelvic floor exercise, which may require the help of a physical therapist to do properly, and reducing pelvic floor strain, such as by losing weight, may help manage genital prolapse. A pessary, a small device inserted into the vagina to strengthen the pelvic wall near the upper vagina, may also be inserted by a doctor as a short- or long-term solution. In some cases, the patient requires surgery to remedy the symptoms of the prolapse and regain sexual, bladder, and bowel function. Some surgeries may include removal of the uterus or hysterectomy in women with uterine prolapse who no longer want to have children, vaginal vault repair, and vaginal repair.
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