Diagnosing vaginal prolapse: Is your quality of life being affected?

Symptoms of vaginal prolapse, such as chronic infections, ulcerations or disruption to sexual activity, can be very troublesome. In this informative article on vaginal prolapse, renowned consultant obstetrician and gynaecologist Professor Stergios Doumouchtsis, who specialises in urogynaecology, explains how the condition can affect women’s quality of life. The leading expert also sheds light on the diagnostic process and available treatment options for vaginal prolapse.

How is vaginal prolapse defined?

Pelvic organ prolapse (POP) is a condition that refers to the bulging or the herniation of one or more pelvic organs into or out of the vagina. It could be related to prolapse of the uterus, the bladder, the bowel or just the vaginal tissues. Pelvic organ prolapse occurs when the fascia, the ligaments or the muscles, which support these organs become weak and damaged. This primarily occurs following childbirth or as an effect of ageing but can also be caused by other chronic factors such as being overweight, persistent straining with constipation, routine weightlifting or coughing.

If left untreated, can vaginal prolapse pose a serious risk?

In most cases, prolapse of a mild or moderate degree has mild symptoms or in some cases, doesn’t cause any issues at all and therefore does not appear to carry additional risks.

In cases of severe prolapse, for example, when the bladder is protruding through the vaginal opening, there are risks of voiding dysfunction of the urinary tract with high volumes of urine retained even after passing urine. This poses related risks of urinary tract infections, which in some severe cases may result in a pyelonephritis or sepsis with additional risks of hydronephrosis. This is uncommon but can occur in severe cases of prolapse of the bladder. In some other cases, the mere friction of the vaginal tissues against clothes and underwear can cause ulceration and vaginal infections.

How is vaginal prolapse diagnosed?

The diagnosis of a pelvic organ prolapse is clinical and is based on a physical examination whereby a woman is asked to strain (to produce what we call a Valsalva manoeuvre) so that the doctor can observe the maximum descent of the pelvic organs. Usually women present to our clinics when there are bothersome symptoms or when there is an incidental finding during a routine examination, for example, during a cervical smear.

By diagnosing this condition we can offer reassurance first of all, as many women are worried when they see or feel a bulge protruding through the vaginal opening. We can also give advice about measures to prevent further worsening of the prolapse as well as treatment options, which range from conservative to surgical treatments.

One of the options available to patients with mild cases is to monitor the symptoms without taking any specific actions to treat the prolapse. Nonetheless, it is important to maintain healthy pelvic floor muscles by performing pelvic floor exercises. In order to prevent further worsening of the prolapse, patients should also avoid risk factors, such as:

• heavy weight lifting or exercises with weights
• chronic constipation and straining
• being overweight

How is vaginal prolapse treated?

The most common treatment options for a pelvic organ prolapse include pelvic floor exercises, vaginal pessaries, such as ring pessaries, which are devices that are inserted into the vagina to help support the prolapsing pelvic organs. The surgical treatment options include vaginal, abdominal and laparoscopic procedures. In some cases, robotic procedures can also help to correct the anatomical defects behind the prolapse.

When is surgery deemed necessary for vaginal prolapse?

Surgery is considered necessary in cases of severe prolapse when the function of the pelvic organs is affected. This could relate to urinary tract function, in patients with a severe bladder prolapse or could be prompted by chronic ulcerations and infections of the vaginal epithelium.

Surgery may also be deemed necessary when the symptoms are particularly bothersome and the woman’s quality of life is significantly affected. Other functional disorders could include a difficulty in emptying bowels as well as sexual dysfunction.

If you are seeking treatment for vaginal prolapse and wish to book a consultation with Professor Doumouchtsis, you can do so by visiting his Top Doctors profile.