Vaginal Vault Prolapse

Vaginal prolapse or vaginal vault prolapse is caused when the upper portion of the vagina gets weak and folds up into the vaginal canal. Also called the birth canal, the vagina connects the uterus to the outside of the woman’s body. 

The vagina rests on the pelvic area of the body along with other organs. With age, this support framework starts to weaken and results in the sagging of the organs causing them to slide out of their normal position, referred to as a prolapse. There are different types of prolapse with several organs in the pelvic region shifting out of place, causing a prolapse. 

They include:

Vaginal vault prolapse: The top of the vagina is termed the vaginal vault. This folds down and collapses into the vaginal canal. This condition usually occurs in women who have had a removal of the uterus, a process called hysterectomy.

Uterine prolapse: In this case, the uterus bulges or slides into the vagina, sometimes is drops down enough to protrude out of the vaginal opening. Cystocele: In this case the urinary bladder slides into the vagina.

Urethrocele: In this condition, the urethra (the tube that conducts the urine from the urinary bladder) protrudes into the vagina. Often, a cystocele and urethrocele occur together. Rectocele: In the case of a rectocele, the rectum bulges out of the vagina.

Enterocele: A bulge in the small intestine pushes against the back surface wall of the vagina. An enterocele often occurs along with a vaginal wall prolapse.

How common is vaginal prolapse?
Vaginal prolapse is a fairly common condition. Statistics show that a prolapse usually occurs in elderly women particularly if they have had several childbirths and vaginal deliveries.

Symptoms and causes
Symptoms of a vaginal prolapse include heaviness in the pelvic area, backache, a bulge protruding out of the vagina that makes standing and walking difficult, urinary incontinence or vaginal bleeding, difficulty in having a bowel movement, and problems in sexual intercourse.

Common causes include:
Childbirth: Vaginal delivery increases the risk of prolapse compared with that of a C section. The perception is also that the more children a woman delivers, and larger the babies are, the more the risk of a vaginal prolapse.

Surgery: Procedures like a hysterectomy or radiation treatments in the pelvic area could also cause a vaginal prolapse. 

Menopause: At the time of menopause, the ovaries cease to produce hormones that regulate the monthly period. Also hormone estrogen is especially crucial as it helps to keep the pelvic muscles strong. When the body reduces its production of estrogen, the pelvic muscles become weak and could cause a prolapse.

Other common causes include aging, intense physical activity involving lifting of physical objects, or genetic factors. Other conditions could include being overweight, stressing to pass bowels or those with a chronic cough.

Diagnosis and tests
A vaginal prolapse is diagnosed by the doctor who learns about the symptoms such as fullness in the pelvic area, urinary incontinence and conducts a physical exam. The doctor also ascertains the family’s history and previous pregnancies if any.

Treatments
Treatments for vaginal prolapse vary depending on the intensity of the prolapse. The doctor could decide to observe it for some time ensuring it does not worsen over this period. Several surgical and non-surgical treatments are available for vaginal prolapses, similar to those for uterine prolapses. The doctor will decide on these options dependent on the age and condition of the patient.

Usually, non-surgical treatments are recommended as a first option and works for minimal prolapses. These treatments include tightening of the pelvic muscles that what are popularly known as Kegel exercises. Here, the patient is advised to tighten the pelvic muscles as if trying to hold back urine. This should be done ten times 3-4 times a day.

Interventions/ surgeries Vaginal Pessary: A Pessary is a small doughnut shaped device made of plastic or rubber inserted into the woman’s vagina. This acts as a support structure holding things in place. This is fitted and inserted by the doctor and the patient is advised to clean it frequently to maintain hygiene.

Vaginal vault suspension: This is a procedure where the vagina is attached to the ligaments inside the pelvis that were responsible for holding it up. The surgery is done through a cut (incision) in the vagina. Sacrocolpopexy: In this procedure a piece of mesh is attached to the vagina and the mesh is secured to the tailbone, which gives the vagina a lift. This surgery is performed by laparoscopy which involves making small incisions in the abdomen.

Colpocliesis: In this procedure the vagina is stitched to close. In this case the risk of another prolapse is low but once this is done there is no possibility of the woman having penetrative sex. This is usually done in older women with a prolapse.

At Motherhood Hospitals, we have a team of highly qualified and experienced gynecologists and surgeons capable of treating a range of maternity related conditions involving girls and women of all ages – from teens to those in their 60s and beyond. Do take an appointment with our doctor and consult them in case you are suffering from a condition or a problem you need addressed. The doctor will order will the required tests and investigations and assess the situation to offer appropriate treatment ensuring you lead an active life.