Vaginal prolapse
Encyclopedia
Female genital prolapse (or vaginal prolapse) is characterized by a portion of the vaginal canal protruding from the opening of the vagina
. The condition usually occurs when the pelvic floor
collapses as a result of childbirth.
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
. The condition usually occurs when the pelvic floor
Pelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...
collapses as a result of childbirth.
Types
- CystoceleCystoceleA cystocele is a medical condition that occurs when the tough fibrous wall between a woman's bladder and her vagina is torn by childbirth, allowing the bladder to herniate into the vagina. Urethroceles often occur with cystoceles....
(bladder into vagina) - EnteroceleEnteroceleAn enterocele is a protrusion of the small intestines and peritoneum into the vaginal canal.It may be treated transvaginally or by laparoscopy....
(small intestine into vagina) - RectoceleRectoceleA rectocele results from a tear in the rectovaginal septum . Rectal tissue bulges through this tear and into the vagina as a hernia...
(rectum into vagina) - UrethroceleUrethroceleA urethrocele is the prolapse of the female urethra into the vagina. Weakening of the tissues that hold the urethra in place cause it to move and to put pressure on the vagina, leading to the descent of the anterior distal wall of the vagina. Urethroceles often occur with cystoceles,...
(urethra into vagina) - Uterine prolapseUterine prolapseUterine prolapse is a form of female genital prolapse Uterine prolapse is a form of female genital prolapse Uterine prolapse is a form of female genital prolapse (also called pelvic organ prolapse or prolapse of the uterus (womb).Treatment is surgical, and the options include hysterectomy or a...
(uterus into vagina) - Vaginal vaultVaginal vaultThe vaginal vault is the expanded region of the vaginal canal at the internal end of the vagina.The vaginal vault may prolapse after a hysterectomy , leading to a prolapse of the vaginal vault or a vaginal vault prolapse....
prolapse (roof of vagina) - after HysterectomyHysterectomyA hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
Grading
They are graded either via the Pelvic Organ Prolapse Quantification (POP-Q) system or the Baden-Walker System.| Grade | posterior urethral descent, lowest part other sites |
|---|---|
| 0 | normal position for each respective site |
| 1 | descent halfway to the hymen |
| 2 | descent to the hymen |
| 3 | descent halfway past the hymen |
| 4 | maximum possible descent for each site |
| Stage | description |
|---|---|
| 0 | No prolapsel anterior and posterior points are all -3 cm, and C or D is between -TVL and -(TVL-2) cm. |
| 1 | The criteria for stage 0 are not met, and the most distal prolapse is more than 1 cm above the level of the hymen (less than -1 cm). |
| 2 | The most distal prolapse if between 1 cm above and 1 cm below the hymen (at least one point is -1, 0, or +1). |
| 3 | The most distal prolapse is more than 1 cm below the hymen but no further than 2 cm less than TVL. |
| 4 | Represents complete procidentia or vault eversion; the most distal prolapse protrudes to at least (TVL-2) cm. |
Therapy
Vaginal prolapses must be treated according to the severity of symptoms. They can be treated:- With conservative measures (changes in diet and fitness, Kegel exerciseKegel exerciseA pelvic floor exercise, more commonly called a Kegel exercise , consists of contracting and relaxing the muscles that form part of the pelvic floor, which are now sometimes colloquially referred to as the "Kegel muscles". Several tools exist to help with these exercises, though many are ineffective...
s, etc.) Also included are alternative measures proposed by Whole Woman (TM) which believes that prolapse usually occurs slowly, over time, due to changes in the natural pelvic organ support system, and that it can be controlled and even reversed, naturally, through proper posture and lifestyle. - With a pessaryPessaryA pessary is a small plastic or silicone medical device which is inserted into the vagina or rectum and held in place by the pelvic floor musculature. - Therapeutic pessaries :...
, to provide support to the weakened vaginal walls - With surgerySurgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
. Surgery is used to treat symptoms, such as bowel or urinary problems, pain, or a prolapse sensation. A Cochrane CollaborationCochrane CollaborationThe Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...
review found that limited data are available on optimal surgical approaches, including the use of surgical mesh, in the form of a patch or sling, similar to its implementation for abdominal herniaHerniaA hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm....
. Further development of techniques and more research is essential in order to improve outcomes from surgery.