What Is Vaginal Prolapse?
9 Common Symptoms Specific to Certain Types of Vaginal Prolapse
4 Common Causes of Vaginal Prolapse
A polypectomy is usually carried out at the same time as a colonoscopy. During a colonoscopy, a colonoscope will be inserted into your rectum so your doctor can see all segments of your colon. A colonoscope is a long, thin, flexible tube with a camera and a light at the end of it.
A colonoscopy is offered routinely for people who are over 50 years old to check for any growths that could be indicative of cancer. If your doctor discovers polyps during your colonoscopy, they’ll usually perform a polypectomy at the same time.
There are several ways in which a polypectomy can be performed. Which way your doctor chooses will depend on what kind of polyps are in the colon.
Polyps can be small, large, sessile, or pedunculated. Sessile polyps are flat and don’t have a stalk. Pedunculated polyps grow on stalks like mushrooms. For small polyps (less than 5 millimetres in diameter), biopsy forceps can be used for removal. Larger polyps (up to 2 centimetres in diameter) can be removed using a snare.
In snare polypectomy, your doctor will loop a thin wire around the bottom of the polyp and use heat to cut the growth off. Any remaining tissue or stalk is then cauterized.
Some polyps, due to a large size, location, or configuration, are considered more technically challenging or are associated with an increased risk of complications. In these cases, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) techniques can be used.
In EMR, the polyp is lifted from the underlying tissue using a fluid injection before resection is performed. This fluid injection is often made of saline. The polyp is removed one piece at a time, called piecemeal resection. In ESD, fluid is injected deep in the lesion and the polyp is removed in one piece.
For some larger polyps that can’t be removed endoscopically, bowel surgery may be needed.
Once a polyp has been removed, it’ll be sent to a pathology lab to test if the polyp is cancerous. The results usually take one week to come back, but sometimes can take longer.A network of muscles provides the main support for the pelvic viscera (the vagina and the surrounding tissues and organs within the pelvis). The major part of this network of muscles, which is located below most of the pelvic organs and supports the organs’ weight, is called the levator ani. Pelvic ligaments provide additional stabilizing support.
When parts of this support network are weakened or damaged, the vagina and surrounding structures may lose some or all of the support that holds them in place. Collectively, this condition is called pelvic relaxation. A vaginal prolapse occurs when the weight-bearing or stabilizing structures that keep the vagina in place weaken or deteriorate. This may cause the supports for the rectum, bladder, uterus, small bladder, urethra, or a combination of them to become less stable.
Common factors that may cause a vaginal prolapse
Childbirth (especially large babies): Childbirth is damaging to the tissues, muscles, and ligaments in and around the vagina. Long, difficult labors and large babies are especially stressful to these structures. Childbirth is the risk factor most commonly associated with cystoceles, in which the bladder prolapses into the vagina. A cystocele is sometimes accompanied by a urethrocele, in which the urethra becomes displaced and prolapses. A cystocele and urethrocele together are called a cystourethrocele.
Menopause: Estrogen is the hormone that helps to keep the muscles and tissues of the pelvic support structures strong. After menopause, the estrogen level declines; and the support structures may weaken.
Hysterectomy: The uterus is an important part of the support structure at the top of the vagina. A hysterectomy involves removing the uterus. Without the uterus, the top of the vagina may gradually fall toward the vaginal opening. This condition is called a vaginal vault prolapse. As the top of the vagina falls, added stress is placed on other ligaments. Hysterectomy is also commonly associated with an enterocele, in which the small intestine herniates downward near the top of the vagina.
Other risk factors of vaginal prolapse include advanced age, obesity, dysfunction of the nerves and tissues, abnormalities of the connective tissue, strenuous physical activity, and prior pelvic surgery.
5 Types of Vaginal Prolapse
Rectocele (prolapse of the rectum): This type of vaginal prolapse involves a prolapse of the back wall of the vagina (rectovaginal fascia). When this wall weakens, the rectal wall pushes against the vaginal wall, creating a bulge. This bulge may become especially noticeable during bowel movements.
Cystocele (prolapse of the bladder, dropped bladder): This can occur when the front wall of the vagina (pubocervical fascia) prolapses. As a result, the bladder may prolapse into the vagina. When this condition occurs, the urethra usually prolapses as well. A urethral prolapse is also called a urethrocele. When both the bladder and urethra prolapse, this condition is known as a cystourethrocele. Urinary stress incontinence (urine leakage during coughing, sneezing, exercise, etc) is a common symptom of this condition.
Enterocele (herniated small bowel): The weakening of the upper vaginal supports can cause this type of vaginal prolapse. This condition primarily occurs following a hysterectomy. An enterocele results when the front and back walls of the vagina separate, allowing the intestines to push against the vaginal skin.
Prolapsed uterus (womb): This involves a weakening of a group of ligaments called the uterosacral ligaments at the top of the vagina. This causes the uterus to fall, which commonly causes both the front and back walls of the vagina to weaken as well. Stages of uterine prolapse are:
1. First-degree prolapse: The uterus droops into the lower portion of the vagina.
2. Second-degree prolapse: The uterus falls to the level of the vaginal opening.
3. Third-degree prolapse: The cervix, which is located at the bottom of the uterus, sags to the vaginal opening and protrudes outside the body. This condition is also called procidentia, or complete prolapse.
4. Fourth-degree prolapse: The entire uterus protrudes entirely outside the vagina. This condition is also called procidentia, or complete prolapse.
Vaginal vault prolapse: This type of prolapse may occur following a hysterectomy (surgical removal of the uterus). Because the ligaments surrounding the uterus provides support for the top of the vagina, this condition is common after a hysterectomy. In vaginal vault prolapse, the top of the vagina gradually falls toward the vaginal opening. This may cause the walls of the vagina to weaken as well. Eventually, the top of the vagina may protrude out of the body through the vaginal opening, ultimately turning the vagina inside out. A vaginal vault prolapse is often accompanied by an enterocele.
A large percentage of women develop some form of vaginal prolapse during their lifetime, most commonly following menopause, childbirth, or a hysterectomy. Most women who develop this condition are older than 40 years of age. Many women who develop the symptoms of a vaginal prolapse do not seek medical help because of embarrassment or other reasons. Some women who develop a vaginal prolapse do not experience symptoms.
Questions to Ask the Doctor about Prolapsed Vagina
• How will the vaginal prolapse affect sexual relations?
• Will the condition affect the ability to have children?
• Are any nonsurgical treatments options appropriate?
• When is surgical repair necessary?
When to Call a Doctor and Seek Medical Help for a Prolapsed Vagina
Exams, Procedures, and Tests to Diagnose Vaginal Prolapse
How to Treat Vaginal Prolapse
Vaginal Prolapse Self-Care at Home
Treatments at home for vaginal prolapse.
Activity modification: For a vaginal prolapse that causes minor or no symptoms, the doctor may recommend activity modification such as avoiding heavy lifting or straining.
Pessary: A pessary is a small device, usually made of soft plastic or rubber, that is placed within the vagina for support. Pessaries come in many different varieties. This nonsurgical treatment option may be the most appropriate for women who are not sexually active, cannot have surgery for medical reasons or because of advanced age, or plan to have surgery but need a temporary nonsurgical option until surgery can be performed (for example, women who are pregnant or in poor health). Pessaries must be removed and cleaned at regular intervals to prevent infection or erosion into the vaginal walls. Some pessaries are designed to allow the woman to do this herself. A doctor must remove and clean other types. Oestrogen cream is commonly used along with a pessary to help prevent infection and vaginal wall erosion. Some women find that pessaries are uncomfortable or that they easily fall out or that they cannot be retained (i.e., they fall out).
Kegel exercises: These are exercises used to tighten the muscles of the pelvic floor. Kegel exercises can be tried to treat mild-to-moderate cases of vaginal prolapse or to supplement other treatments for prolapses that are more serious.
Vaginal Prolapse Medical Treatment
Vaginal Prolapse Medications
Oestrogen replacement therapy may be used to help the body strengthen the muscles in and around the vagina. Oestrogen replacement therapy may be contraindicated (such as in a people with certain types of cancer) and has been associated with certain health risks including increased risk of blood clots and stroke, particularly in older postmenopausal women. Women’s bodies cease producing oestrogen naturally after menopause, and the muscles of the vagina may weaken as a result.
In mild cases of vaginal prolapse, oestrogen may be prescribed in an attempt to reverse vaginal prolapse symptoms, such as vaginal weakening and incontinence. For more severe prolapses, oestrogen replacement therapy may be used along with other types of treatmenT.
Vaginal Prolapse Surgery and Recovery
Alternative Therapy for Vaginal Prolapse
Physical therapy such as electrical stimulation and biofeedback may be used to help strengthen the muscles in the pelvis.
Electrical stimulation: A doctor can apply a probe to targeted muscles within the vagina or on the pelvic floor. The probe is hooked up to a device that measures and delivers small electrical currents that contract the muscles. These contractions help strengthen the muscles. A less intrusive type of electrical stimulation is available that magnetically stimulates the nerve that supplies the pelvic floor muscles from outside the body. This activates these and may help treat incontinence.
Biofeedback: A sensor is used to monitor muscle activity in the vagina and on the pelvic floor. The doctor can recommend exercises that the woman can use to strengthen these muscles. In some cases, these exercises may help strengthen the muscles enough to reverse or relieve some symptoms related to vaginal prolapse. The sensor can monitor the muscular contractions during the exercises, and the doctor may be able to determine if the targeted muscles would benefit from the exercises.
Vaginal Prolapse Follow-up
Vaginal Prolapse Prognosis and Cure
• Vaginal prolapse is rarely a life-threatening condition.
• Some mild cases can be treated without surgery.
• More severe cases of vaginal prolapse will likely require surgery for correction.
• Vaginal prolapse surgery is generally successful, but recurrence remains an issue.