What you need to know about vaginal prolapse

Vaginal prolapse is incredibly common, affecting up to 40 percent of postmenopausal women, according to some research. Yet this highly treatable condition is rarely talked about—some women even hesitate to tell their OBGYN about their symptoms. We spoke with Nina Casanova, MD, a urologist at Sky Ridge Medical Center in Denver, Colorado, to learn more about vaginal prolapse, and to find out what you can do about it.

What is vaginal prolapse?

Pelvic organ prolapse (POP), often called “vaginal prolapse,” happens when the tissues at the base of your abdomen weaken, or relax. These tissues normally hold up important structures like your bladder, uterus, and rectum. When pelvic tissues weaken, those organs can drop down from their original positions and press against the vagina. In some cases, they droop into the vagina, and may bulge out through the vaginal opening.

Some women are especially prone to POP because of genetics, says Casanova, but carrying babies and going through menopause are also key risk factors. Women who have vaginal deliveries, are overweight, or undergo hysterectomy are at higher risk as well. Additionally, heavy lifting might contribute to POP since it increases the pressure on your lower abdomen, but more research is needed to confirm this.

Symptoms of prolapse

Many women with vaginal prolapse have no symptoms, or some report subtle sensations that can be difficult to describe. “It can feel strange,” says Casanova. “Some people report abdominal pressure, or pressure on their bladder. Others say their vagina feels ‘squishy,’ or that ‘something just doesn't seem right.’"

Symptoms often vary depending on how severe the prolapse is, and which organs are involved. You might experience:

• Discomfort during sex
• Light bladder leakage or urinary incontinence. “It’s possible for the urethra, or the tube that goes from the bladder to the outside world, to get kinked as well,” mentions Casanova. In that case, you wouldn’t leak urine, but you may need to press a finger against the vaginal bulge to “unkink” it so that you can pee.
• Constipation. If your rectum has moved out of place and is “ballooning” into the vagina, it can make it difficult to have an effective bowel movement.
• Tissue irritation. If sensitive tissue is exposed through the vaginal opening, friction from rough fabrics or tight clothing can cause irritation.

You may also feel like something’s heavy, or pulling against your lower back. Lying down sometimes relieves this sensation.

How is vaginal prolapse diagnosed?

Make an appointment with your OBGYN if you experience any of these symptoms. Vaginal prolapse is common, but it shouldn’t just be an expected part of aging—there are plenty of ways to treat it.

Your OBGYN will do a physical assessment and ask about your symptoms. Your doctor will then examine your vagina to confirm that you have prolapse and decide how severe it is.

In order to determine exactly which organs are involved, some women may need additional testing, such as:

• Pelvic floor ultrasound: For this type of ultrasound, a technologist will place a wand between your labia minora, or the small, inner lips of your vagina. The wand uses sound waves to create an image of your pelvic floor organs on a monitor.
• Magnetic resonance imaging (MRI): An MRI uses a powerful magnet to create 3D images of your pelvic structures.
• Cystourethroscopy: For this procedure, your doctor will insert a thin tube into your urethra. The tube has a tiny camera at the end, which allows your healthcare provider to see the inside of your urethra and bladder.

Treating vaginal prolapse

Kegel exercises can help with mild cases of POP and strengthen the muscles that control your bowel and bladder functions. Here’s how to do them:

• Empty your bladder.
• Sit or lie down comfortably.
• Squeeze the muscles you use to hold in pee for a count of eight to ten seconds.
• Relax them for ten seconds.
• Repeat the exercise ten times; do this routine three times a day, or as directed by your OBGYN.

However, before starting Kegels, ask your doctor if a home regimen is right for your individual case. Targeted physical therapy is sometimes more appropriate. “Also, Kegels can help with a small degree of prolapse, but if you've already had a sizeable tear in your pelvic floor tissue, Kegels aren’t going to repair it,” Casanova explains.

Another option is to use a pessary, a device that’s placed in the vagina to help it hold its shape. It can come in a variety of shapes and sizes depending on your anatomy, and is usually made specifically to fit your vagina. “A well-fit pessary can work out really well for some people, especially if they're not a candidate for surgery, or they’d just like to avoid it. A pessary can also bridge the time until your surgery happens,” she says.

There are a number of surgical options for POP, but the specific procedure your doctor recommends will depend on the type of prolapse you have and how severe it is.

The bottom line: “Women need to know that if vaginal prolapse is bothersome, they don't have to live with it,” says Casanova. “I see a lot of women taking care of everybody else before themselves and not addressing their own needs—even though treatment can make their lives so much better.”