Vaginal wall prolapse: how does it occur, what are the different types and how is it repaired?

Women who have had many vaginal deliveries during childbirth may experience and suffer from a condition called vaginal wall prolapse. This condition is the medical term used to refer to the vagina slipping or sliding out of its position. 

Here to give us an insight into the condition's different types and its treatment procedure is highly experienced consultant gynaecologist, Dr Avanti Patil. 

What is vaginal wall prolapse?

The pelvic floor muscles form a hammock across the opening of the pelvis. These muscles, together with their surrounding tissue, are responsible for keeping all of the pelvic organs (bladder, uterus, and rectum) in place. Prolapse occurs when the pelvic floor muscles, their attachments, or the vaginal tissue become weak.

This usually occurs due to damage at the time of childbirth, but is most noticeable after menopause, which is when the quality of supporting tissue deteriorates significantly. This debilitating condition is also caused by chronic strain, i.e., heavy lifting, repeated coughing and constipation.

What is anterior vaginal wall prolapse?

An anterior vaginal wall prolapse (also called a cystocele) is a prolapse of the front wall of the vagina where the bladder bulges into the vagina. This sometimes can be large and can push out of the vagina especially upon straining.

A large cystocele may cause or be associated with urinary symptoms such as urinary leakage, urinary urgency (strong and sudden desire to pass urine), having to pee frequently, difficulty passing urine, or a sensation of incomplete emptying. Some women have to push the bulge back into the vagina or lean forward in order to completely empty the bladder.

Incomplete bladder emptying may result in you becoming prone to bladder infections (Urinary Tract Infection). A handful of women find that the bulge causes a dragging or aching sensation, or can often experience a sensation of discomfort when engaging in sexual intercourse.

What is a posterior vaginal wall prolapse?

A posterior vaginal wall prolapse (also called a rectocele or a rectoenterocele) is a prolapse of the back wall of the vagina. The rectum (bowel) bulges through the vagina. The perineum is the area between the vagina and the back passage. It provides some support for the vagina and may be damaged during childbirth.

Upon straining, the weakness described above allows the rectum (back passage) to bulge into the vagina and, occasionally, also bulge out of the vagina (rectocele). A large rectocele may result in extreme difficulty to have a bowel movement, especially if you are suffering from constipation at that given moment in time.

In fact, in extreme cases, some women are forced to push the bulge back into the vagina, support the perineum, or indeed insert a finger into the back passage in order to complete a bowel movement.

What is the difference between an anterior and posterior vaginal repair? 

An anterior vaginal repair (colporrhaphy) is an operation performed within the vagina to treat an anterior (front) vaginal wall prolapse. A posterior vaginal repair (colporrhaphy), meanwhile, is an operation performed within the vagina to treat a posterior (back) vaginal wall prolapse. Posterior repair is often combined with a repair of the area between the vagina and the back passage, often referred to as the perineum (perineorrhaphy).

How is the anterior or posterior vaginal wall repair performed?

The operation is usually performed under general anaesthetic. A spinal anaesthetic can also be used, which entails an injection being injected into the back to numb the patient from the waist down. 

The operation is carried out vaginally. It involves the repairing of the supportive tissues through the use of dissolvable stitches. On average, these stitches normally take between four to six weeks to dissolve, although some surgeons incorporate the use sutures, which take roughly between three to six months to completely dissolve.

This should not affect a patient’s recovery time. If the perineum is repaired, you might notice a few stitches on the outside but these will dissolve and fall away fairly quickly.

Occasionally, a catheter and a vaginal pack (gauze tampon) may be inserted into the vagina upon completion of the operation. However, this is not essential and depends entirely on the preference of the surgeon and their method of operating.

Dr Avanti Patil is a highly experienced and qualified consultant gynaecologist. If you have any concerns relating to the vaginal area, you can check out Dr Patil's Top Doctor's profile to book a consultation with her.