By Amy S. D. Lee, MS, WHCRNP, Nurse Practitioner
When I start thinking about how the force of gravity tugs and pulls on the female body, I usually reflect on the various parts of me that I can see have begun to sag!
Unfortunately, gravity can cause some of our organs, such as the uterus, to fall down or slip out of place. But there are ways to handle this condition, which we in medicine commonly refer to by the catchall term, prolapse. Prolapse literally means "to fall out of place," and it affects the vagina and the bladder as well.
What is prolapse?
Prolapse is a condition in which the pelvic organs begin to sag into, and even out of, the vagina. There are varying degrees of severity of prolapse, and the severity of the symptoms a woman will experience are usually related to the degree or extent of the prolapse.
Women who have never had children may have prolapse, but it's more common in women who have had vaginal deliveries. Other factors contributing to prolapse include
- older age
- heavier weight
- constipation
- prolonged cough
- pelvic tumors (like heavy uterine fibroids)
- perhaps a genetic predisposition
Common Symptoms of Prolapse
- pelvic pressure
- feeling of vaginal fullness
- leakage of urine
- pain with sex
- constipation (both a cause and a symptom)
Diagnosis
Diagnosis of mild prolapse can be made during a pelvic exam at your GYN visit. A more severe prolapse sometimes will become evident when the pelvic organs can be seen or felt protruding from the vagina. Your healthcare provider should then confirm the diagnosis with a pelvic exam.
While it can be quite alarming to discover that you have prolapse, it’s usually a pretty benign condition that can be corrected.
Treatment
Treatment of a prolapse often depends on the severity of both the prolapse and the symptoms. Mild prolapse can often be treated with vaginal topical estrogen andvaginal exercises (Kegel exercises), both of which strengthen the vaginal walls. Other tactics for treating milder prolapses include avoiding heavy lifting and avoiding caffeine (which acts as a diuretic).
More severe prolapse can be treated with a device called a pessary. Pessaries come in a variety of designs and are fitted by your healthcare provider. They stay in the vagina and lift the organs back into normal position. (No, you can't feel them.)
Last, the most severe cases of prolapse can be addressed with surgery. Severe uterine prolapse may require a hysterectomy, followed by repair of the vaginal muscles to lift the bladder back into position. There are also surgical procedures that can be done to suspend the bladder to or from other parts of the abdomen. Women who do not plan to ever be sexually active again may choose to have a procedure that closes the vagina, thereby lifting the organs into place and preventing them from falling back down.
What if you think you have prolapse?
The first thing ALL women should be doing--whether they have a prolapse condition or not--is the Kegel exercises. We should start doing them early (even as teens and young adults) to keep the vaginal muscles strong. Practice by squeezing the vaginal muscles (like starting and stopping the stream of urine) 10 times at least 10 times per day. If you are concerned that you have prolapse, or are at risk of prolapse, discuss your situation with your healthcare provider. Early intervention is an important part of prevention.
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