Vaginal Prolapse

Vaginal prolapse is when the top of vagina (vaginal vault) or nearby organs fall in the vaginal canal from their normal position. The vagina is the tunnel that connects the uterus to the outside of the body. It is commonly known as the birth canal. 

Vaginal prolapse occurs when the muscles in the pelvic region weaken and loosen up and no longer support one or more organs located in the pelvic area.

The actual cause of vaginal prolapse is still unknown. The pelvic floor supports organs such as the vagina, uterus, rectum, urethra, and bladder. The pelvic muscles, ligaments, and connective tissue weaken due to childbirth, injury, surgery, and other factors. It leads to muscles collapsing and organs, including the vagina bulging out. The cause of vaginal prolapse may also be multiple vaginal deliveries. In severe cases, the organs can protrude outside of the vagina too.

1. Many times  women experience no symptoms at all. The most common symptom of vaginal prolapse is the sensation of tissue coming down. Some of the signs and symptoms of vaginal prolapse are:
2. Pain at the time of sexual intercourse
3. Mass or tissue at the opening of the vagina
4. Difficulty emptying bowel and bladder
5. Organs popping out of the vagina
6. Recurrent UTIs
7. Pain which increases at the time of menstruation
8. Urinary continence
9. A feeling of heaviness and fullness in the pelvic area
10. Lower back pain
11. Difficulty inserting tampons or applicators
12. Vaginal dryness

Diagnosis

The following tests are performed by doctors for the diagnosis of vaginal prolapse such as :

1. Physical examination: The doctor will insert the gloved fingers inside the vagina to check for prolapse or vagina fallout.
2. Q-Tip Test: In this method, the doctor inserts a cotton-tipped applicator with anaesthetic gel into the urethra.
3. Pelvic floor strength: The doctor assesses the strength of the pelvic floor and sphincter muscles along with the strength of muscles, ligaments, and connective tissue which supports the vagina. The findings help the doctor to determine kegel exercises to restore strength.
4. Bladder function test tests the bladder's ability to store and dispose of urine. The information is essential to select the type of treatment and stage of vaginal prolapse.
5. Ultrasound uses sound waves to allow the doctor to evaluate the vaginal prolapse.
6. Magnetic resonance imaging (MRI) scan: This diagnostic tool uses magnetic waves. These are later analysed by computer and produce a 3D image of

Treatment

The prolapse treatment depends on the severity and stage of the vaginal prolapse. There are both surgical and non-surgical options available for treatment, such as:

1. Exercises:  The kegel exercises help in strengthening the muscles of the pelvic. In this, you need to tighten your pelvic muscles as if you are trying to hold urine. Hold this for a few seconds, then release. Repeat the same ten times. It would be best to do it 4-5 times a day.
2. Pessary: The doctor inserts the vaginal pessary into the vagina. It helps in holding things in place. A vaginal pessary is made of plastic and rubber and is usually in the shape of a ring, doughnut, or "O". It acts as a support device and is needed to clean frequently. It must be removed before having sex.
3. Vaginal vault suspension: In this procedure, the surgeon cuts the vagina. Then vagina is attached to the ligaments inside the pelvis. It brings the vagina back in its normal position.
4. Sacrocolpopexy:  In this method, the surgeon attaches the piece of mesh to the vagina. Then to lift the vagina, the mesh is secured to the tailbone. It is usually performed by making minor cuts in the abdomen.
5. Colpocleisis: This is usually performed in stage 4. In this method, the doctor stitches the vagina completely. Once done, you cannot have penetrative sex. It is generally performed in older women. It also decreases the risk of another prolapse.
6. Electrical stimulation: The doctor applies the probe to the vagina or the pelvic floor. The probe is then hooked with a device that delivers electrical currents. The current contracts the muscles that help in strengthening them.
7. Biofeedback: A sensor monitors muscle activity of the pelvic area and vagina. Doctors use this sensor to check the recovery from pelvic exercises.

DISEASE PROGRESSION

The vaginal prolapse progress through the following stages:

1. Stage 0: The pelvic muscles, ligaments, and connective tissue start to weaken and loosen up. But no vaginal prolapse occurs
2. Stage 1: The uterus is still in the upper half of the vagina.
3. Stage 2: In this stage, the uterus is near the opening of the vagina.
4. Stage 3: In this stage, the uterus protrudes from the vagina.
5. Stage 4:  It is the final stage, uterus protrudes out of the body