One in every two women over the age of 45 suffers some sort of vaginal prolapse. Similar to a man’s hernia, except it occurs in the vagina rather than the lower groin, vaginal prolapse arises when muscles and ligaments holding pelvic organs in place weaken or become damaged. This can occur from several causes, such as age, childbirth, menopause, heavy lifting, straining during bowel movements or coughing, obesity, or previous surgeries, such as hysterectomy.
A women’s bladder, uterus, vaginal vault, rectum or small intestine can prolapse, and it’s not uncommon for women to have more than one type of prolapse at the same time. While each prolapse may produce different symptoms, the most common are:
- Heaviness or pulling in the pelvis
- Discomfort or pain
- Tissue protruding from the vagina
- Frequent urination, or a sudden, urgent need to empty the bladder
- Difficulty urinating
- Difficulty emptying bladder or incomplete voiding
- More frequent bladder infections
- Painful intercourse (dyspareunia)
- Low back pain
- Vaginal bleeding or increased vaginal discharge
- Difficulty with bowel movements and/or emptying bowels
- Pain that gets worse when standing
- Difficulty walking
Exhibiting any of the above symptoms warrants visiting a urologist. Timely medical care is critical because a prolapse won’t heal itself, and it can lead to further medical complications.
Beth Israel Department of Urology physicians will conduct a thorough physical exam to determine the type and extent of a prolapse and what type of treatment is most appropriate. Patients also may undergo testing, such as a bladder function test to measure the bladder’s ability to store and empty urine; pelvic floor strength tests; and possible imaging tests—ultrasound or cystoscopy—to further confirm the diagnosis.
While there are no medications for vaginal prolapse, Beth Israel’s Sol and Margaret Berger Department of Urology offers many treatment options to correct vaginal prolapse and improve a woman’s quality of life. No one treatment option for vaginal prolapse is right for all women. That’s why it’s so important to discuss the benefits and risks of each treatment with a Beth Israel urologic specialist to choose the one that is best for you.
- Non-Surgical Treatment. Beth Israel offers traditional, nonsurgical treatments for vaginal prolapse, such as:
- Pessaries, which are rubber or plastic donut-shaped devices placed within the vagina to put a prolapsed bladder or uterus back into place
- Estrogen replacement therapy to strengthen and maintain muscles in the vagina
- Behavior therapy, including simple lifestyle changes, such as losing weight, eating high fiber foods, smoking cessation, and proper lifting techniques, to minimize the frequency and severity of vaginal prolapse symptoms
- Physical therapy and pelvic muscle exercises, known as Kegel exercises, to help strengthen pelvic floor muscles and relieve symptoms of minor prolapse
Surgical treatment. Surgery to correct vaginal prolapse depends on many things, such as the degree of prolapse, desire for future pregnancies, other medical conditions, a women’s wish to retain vaginal function, and her age and overall health. In the past, prolapse surgery was invasive and through the abdomen, requiring a lengthy hospital stay.
Beth Israel surgeons now offer a new, advanced minimally invasive technique to return prolapsed organs to more normal anatomical positions and strengthen structures around the vagina to maintain support of those organs.
Called “transvaginal prolapse surgery,” the procedure minimizes tissue trauma; leaves no visible scarring or incision; restores normal anatomy; has a faster recovery than traditional open abdominal prolapse surgery; lowers the risk for adverse complications; and minimizes pain compared to the more invasive technique.
During the procedure, small incisions are made in the vagina, and synthetic or biologic mesh is used to repair the prolapse and restore normal anatomy. The mesh is light, soft, porous and pliable, and it allows body tissue to grow around it. Once in place, patients don’t feel the mesh inside them. The procedure is done on an outpatient basis or with a one night hospital stay.
What to Expect After Surgery
Patients undergoing transvaginal prolapse surgery not only have no visible scarring and experience less pain and discomfort, but often return to normal activities or work one or two weeks after surgery. However, patients do have to refrain from sexual intercourse, heavy lifting and rigorous exercise for approximately six to eight weeks after surgery to allow everything to heal properly.
Your physician will provide you with all the information needed to care for yourself following surgery.
For a referral to our specialist in female urology, Dr. Sovrin Shah, call the Beth Israel Department of Urology at (212) 844-8926.