Vaginal Prolapse: Causes, Symptoms, and Treatment Options

Vaginal prolapse is a condition in which the pelvic floor structures and muscles weaken, causing the uterus, vaginal walls, bladder, or rectum to descend lower than their normal position. The severity can range from mild discomfort to more advanced cases where the prolapsed organ protrudes outside the vaginal opening. In mild cases, symptoms may present as a sensation of discomfort or a feeling of heaviness in the pelvic area. In more severe cases, prolapse can interfere with urination and bowel movements. If left untreated and the prolapse progresses, it may significantly limit mobility and daily activities. Many women notice that symptoms worsen throughout the day, especially after physical exertion, and tend to feel more pronounced in the evening than in the morning. Persistent discomfort and pelvic pain can also disturb sleep quality and increase stress, which in turn can further aggravate the symptoms.

Pelvic organ prolapse is a common condition, particularly among women who have given birth and as women age. It can significantly impact quality of life, causing symptoms such as urinary incontinence, fecal incontinence, and a sensation of pressure in the pelvic area. Prolapse may also lead to a feeling of vaginal pressure, lower back pain, and discomfort during sexual intercourse. In some cases, prolapse can impair bladder and bowel function, leading to urinary difficulties, recurrent urinary tract infections, or problems with bowel emptying.

What Causes Vaginal Prolapse?

Vaginal and pelvic organ prolapse is primarily caused by the weakening of the pelvic floor muscles and supporting tissues. Several factors can increase the risk of developing prolapse:

• Pregnancy and Childbirth: Vaginal delivery, in particular, stretches and weakens the pelvic floor muscles and connective tissues. Multiple deliveries and large babies further increase the risk of prolapse. During childbirth, the pelvic floor tissues can tear or become damaged, which may predispose women to prolapse over time. The use of delivery aids such as forceps or vacuum extraction can also raise the risk of pelvic floor injury.
• Aging and Menopause: The natural decline in estrogen levels after menopause weakens tissues and muscles. Connective tissues lose their elasticity, reducing support in the pelvic area. Estrogen deficiency can also thin the vaginal walls and impair their ability to recover from physical strain, which can worsen prolapse symptoms.
• Overweight: Excess body weight places additional pressure on the pelvic floor structures, accelerating their weakening. Fat accumulation, especially in the abdominal area, increases intra-abdominal pressure. Long-term obesity can continuously strain the pelvic floor and increase the likelihood of prolapse.
• Heavy Physical Strain: Repetitive heavy lifting, whether through certain occupations or intense sports, can overload the pelvic floor. Activities such as weightlifting or other strength-based sports may gradually increase the risk of prolapse over time. Frequent jumping and high core muscle activation can also raise intra-abdominal pressure, weakening pelvic support tissues over the years.
• Chronic Coughing: Persistent coughing caused by smoking or lung diseases can increase pressure on the pelvic floor and contribute to prolapse over time. A prolonged cough places constant strain on pelvic floor muscles, which can eventually lead to their weakening and prolapse development.
• Constipation and Straining: Chronic constipation and repeated forceful straining during bowel movements can weaken supporting tissues. A fiber-rich diet and adequate hydration can help prevent constipation-related straining. When bowel movements require continuous intense effort, the resulting pressure targets the pelvic floor structures, increasing the risk of prolapse.
• Genetic Factors: Some women have naturally weaker connective tissues, which increases the likelihood of prolapse. Genetic predisposition can affect the durability of pelvic floor tissues throughout life. In some cases, prolapse can be seen in several generations within the same family due to inherited connective tissue weakness.

Different Types of Vaginal Prolapse

There are several types of pelvic organ and vaginal prolapse, depending on which organs have descended:

• Anterior Vaginal Wall Prolapse (Cystocele): The bladder drops and pushes against the front wall of the vagina. This can cause urinary incontinence and discomfort during urination. It may also make it more difficult to fully empty the bladder, increasing the risk of urinary tract infections.
• Posterior Vaginal Wall Prolapse (Rectocele): The rectum descends and can cause difficulty with bowel movements, often leading to a sensation of incomplete emptying. This may worsen constipation and create feelings of pressure and the need for straining during bowel movements.
• Uterine Prolapse: The uterus descends toward or, in severe cases, outside the vaginal opening. This can cause discomfort, pain during intercourse, and urinary difficulties. Uterine prolapse may also affect the support of other pelvic structures, worsening the overall symptoms.
• Vaginal Vault Prolapse: After a hysterectomy, the top portion of the vagina may descend. This can lead to a sensation of heaviness and discomfort in the pelvic area. Vaginal vault prolapse can also cause a feeling of pressure in the lower abdomen and may make sitting or walking uncomfortable.

Different types of prolapse can also occur simultaneously, leading to a wide range of symptoms that can vary from person to person.

Treatment of Vaginal Prolapse

The treatment of vaginal prolapse depends on its severity and the impact of the symptoms on daily life.

• EMSELLA treatment: A specialized device-based therapy that uses electromagnetic stimulation to strengthen pelvic floor muscles without invasive procedures.
• Pelvic Floor Muscle Training: Regular exercises can strengthen the pelvic floor muscles and help prevent or alleviate prolapse.
• Kegel Exercises: Targeted exercises that focus on the pelvic floor muscles. These can be effective in both preventing and relieving prolapse symptoms.
• Pelvic Floor Physiotherapy: Professionally guided exercises and therapeutic techniques that effectively support pelvic floor strengthening.
• Estrogen Therapy: Local estrogen treatments can help strengthen vaginal tissues, especially after menopause.
• Pessary Use: A supportive ring placed inside the vagina that helps hold prolapsed organs in place.
• Prolapse Surgery: In more severe cases, surgical correction may be necessary to restore pelvic support.
• Weight Management and Healthy Lifestyle: Reducing excess weight and preventing constipation can significantly reduce strain on the pelvic floor.