Vaginal Prolapse/Female Stress
If one of the pelvic organs – the bladder, the uterus, the intestines, or the rectum – has fallen down into the vagina, we call it a “dropped bladder” or pelvic organ prolapse. Prolapse ranges in severity from very mild (i.e., prolapse that can only be felt by your doctor on examination) to severe (where one or more of the pelvic organs actually protrude through the vaginal opening). A severe prolapse looks like a red ball protruding from the vagina.
Prolapse happens when the muscles that normally hold the pelvic organs in place become weak. Childbirth (labor and delivery) is the most common cause of weakening of these muscles. The aging process itself, particularly in women who do a lot of heavy lifting, can be another cause.
Performing strengthening exercises called Kegel exercises regularly may help your muscles maintain their strength, helping you avoid prolapse. Many doctors believe that undergoing a cesarean section, instead of natural childbirth, also reduces the likelihood of having prolapse. This does not mean that you should choose a cesarean section for this reason; there are possible complications and if you are thinking about this, you should discuss the issue in detail with your doctor.
If you have prolapse, you may feel pressure in your lower abdomen, vaginal, or rectal area – a feeling that you are “sitting on a ball.” In severe cases, you may actually see the prolapse protruding from the vagina; it may become irritated and cause a discharge or bleeding. Severe prolapse may also make it difficult to urinate, forcing you to push or strain. You may experience a weak urine stream and feel like you have not emptied your bladder. In rare cases, you may be unable to urinate altogether.
Prolapse can cause a variety of problems, including:
- Kidney blockage, which can lead to kidney failure. Fortunately, when the prolapse is repaired the kidneys usually return to normal, provided that the condition is caught early enough.
- Constipation, caused by pushing or straining. You might push the rectum down and the stool can get stuck in a “pocket.”
- Incontinence, with a mild prolapse
- Urethra blockage, with severe prolapse. Sometimes urethra blockage prevents incontinence; in this case, surgical treatment of the prolapse can cause or worsen incontinence. Often, we can diagnose incontinence before we do surgery, and treat it at the same time as the prolapse.
For most people, you, not your doctor, get to decide whether your symptoms are bad enough to warrant treatment. This is not the case if you are experiencing a blockage to the kidney or a severe blockage to the bladder. The treatment options are: pessary and surgery.
A pessary is a device usually made out of plastic usually in the shape of an “O,” a donut or ring. Your doctor will place the pessary into your vagina, like a tampon, to hold organs in place. They can alleviate all of your bladder symptoms. Pessaries come in many sizes and shapes and your doctor will fit it to your vagina. Pessaries are quite safe, though may be associated with recurring bladder infections. You should also have it checked regularly as pessaries can cause inflammation, infection, or even erosion of the vaginal wall. A pessary can be a lifetime treatment. We leave it in place for about three months and either your doctor or you (after proper instruction) can change it. Pessaries may not, however, be effective for all patients.
Fitting the pessary is not simple and relies on trial and error. Your doctor will examine you and try one pessary. Then you walk around and see how it feels. Many people use the pessary only when they need it, such as when they are going out or exercising. The only way to know if a pessary is for you is to try it.
If the pessary does not work for you, or if it leads to incontinence, you might decide that surgery is the best choice for you to create a strong support and keep your organs from falling down. There are many types of surgery prolapse surgery. Some procedures are performed through the abdomen and others through the vagina. While some surgeons use mesh to support the tissue, most – including our doctors at Mount Sinai – use only your own natural tissue for the repair. A third issue is that if your uterus is prolapsed, you may need a hysterectomy as well. In addition, you may need treatment for incontinence. Given all of these variables, it is very important for you to do your homework about the different surgical options and to discuss the particulars of your case with a surgeon in whom you have great confidence.