What Is Vaginal Prolapse?

Learn what can cause the vagina and other pelvic organs to fall from their normal position.

Vaginal prolapse happens when the vagina falls from its normal location inside the pelvis toward the opening of the vagina.

In severe cases of prolapse, the vagina may protrude outside the vaginal opening.

Vaginal prolapse seldom involves just the vagina. Other pelvic organs, including the uterus and bladder, can also fall out of place. This condition may be referred to, collectively, as pelvic organ prolapse.

What Causes Prolapse?

The vagina and other pelvic organs are held in place by muscles and connective tissue. These muscles and tissues may become torn, stretched, or weakened.

Prolapse can happen when these muscles and tissues no longer adequately support the correct position of the pelvic organs.

Risk factors for prolapse include:

• Vaginal childbirth (the more times a woman gives birth, the greater her risk of prolapse)
• Advancing age (prolapse is most common in women over age 60)
• Hysterectomy (surgery to remove the uterus can raise the risk of certain types of prolapse)
• Obesity (overweight or obese women are about twice as likely to experience prolapse as other women)
• Chronic constipation, or trouble passing bowel movements

Types of Vaginal Prolapse

Different types of prolapse involve different parts of the female genitals:

Cystocele This is when the bladder and front wall of the vagina sag toward the vaginal opening. It's sometimes called an anterior prolapse.

Rectocele This is when the rectum and back wall of the vagina fall downward toward the vaginal opening. It's sometimes called a posterior prolapse.

Enterocele This happens when the small bowel slips out of place. It can push down on the uterus or top of the vagina, causing these organs to fall toward the vaginal opening.

Pessary Device for Prolapse

A vaginal pessary is the main nonsurgical treatment option for prolapse.

Pessaries are silicone devices that sit inside the vagina to hold the organs in place. They come in different shapes and sizes.

Your doctor will help you choose the pessary that's right for you based on your lifestyle, self-care abilities, and other factors.

Pessaries must be removed and cleaned on a regular basis. Some types of pessaries are easier than others to insert and remove at home.

Surgery for Prolapse

If prolapse symptoms aren't resolved with a pessary or other nonsurgical treatments, your doctor may recommend surgery.

There are two main surgical approaches to fixing a vaginal prolapse.

One type of surgery involves narrowing or closing off the vagina to provide support for sagging organs.

Vaginal intercourse is no longer possible after this type of surgery.

In the other type of surgery, the surgeon will fix or suspend the sagging organs by repairing the pelvic muscles and tissues that support the pelvic organs.

If the muscles and tissues are too weak, surgical mesh can be used to hold the organs in place.

Transvaginal Mesh

Transvaginal mesh is a material placed through the vagina during surgery to hold prolapsed organs in place.

There are a number of possible complications associated with transvaginal mesh, including:

• Pain
• Bleeding
• Infection
• Mesh erosion

Mesh erosion happens when the mesh moves through the wall of the vagina, where it can damage surrounding organs. Additional surgeries may be needed to fix this problem.

Surgery involving transvaginal mesh is typically reserved for women in whom previous repair attempts have failed, or whose own pelvic support tissues are too weak to repair.