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Genital prolapse, also called pelvic prolapse, is a medical condition in which the organs of the pelvis slip out from their normal positions and drop into the vaginal canal, sometimes protruding out of the vagina. This usually impacts women who have had weakening or injury to the pelvic floor due to pregnancy, childbirth, hysterectomy, a sport that places chronic strain on the pelvic floor, chronic medical conditions — such as obesity — that place pressure on the belly, or due to genetic predisposition.
Types of genital prolapse include cystocele, which affects the bladder, enterocele, which has to do with prolapse of the small intestine, rectocele, or prolapse of the rectum, uterine prolapse, which occurs when the uterus slips out of place, urethrocele, or prolapse of the urethra, and vaginal vault prolapse, which happens when the top of the vagina sags down into the vaginal canal. One of these types of pelvic prolapse may occur independently or with other types of prolapse.
The pelvic floor is a group of muscles and connective tissue that supports the organs of the pelvis and helps control urination. If it is damaged, the organs it supports, such as the uterus and bladder, are at risk of slipping out of place and moving down into the vaginal canal. The most common cause of injury to the pelvic floor is pregnancy and childbirth, though the symptoms of prolapse may not crop up until after menopause, when the pelvic floor begins to further weaken due to the drop in estrogen, a natural female reproductive hormone. Other causes, such as pelvic surgery or chronic pressure on the pelvic floor, also may not show symptoms until later in life.
Symptoms vary based on the type of the genital prolapse. One of the most tell-tale signs, however, is a bulge in the vagina or protrusion out of the vagina. In cystocele, wherein the support structure between the vaginal wall and the bladder weakens, allowing the bladder to fall, the patient may experience a feeling of pressure in the vagina, pain and leaking of urine during sex, trouble controlling urination, especially when bearing down, for example when coughing, frequent bladder infections, and feeling the need to urinate, even after urinating. A patient with urethrocele, in which the urethra falls into the vagina, often has no symptoms or mild versions of the symptoms associated with cystocele.
Enteroceles, in which the small intestine slips out of place and falls into the top of the vagina, most often occurs in women who have had a hysterectomy. These women may experience abdominal pressure and lower back pain that eases when lying down, pressure in the vagina, pain during sex, and a bulge in the vagina.
In rectocele, when the tissue supporting the rectum weakens and allows the rectum to push into the vaginal wall, the woman may present with a protrusion of tissue through the vaginal opening and slight discomfort, but the condition usually isn’t painful and often occurs without symptoms. Vaginal vault prolapse, a condition in which the top of the vagina loses its structural integrity and falls into the vaginal canal, presents with pressure in the pelvis, lower back discomfort, incontinence, vaginal bleeding, and a bulge in the vagina or protruding out of the vaginal opening.
Treatments also vary based on the type and severity of genital prolapse. In some cases, exercise of the pelvic floor, which may require the help of a physiotherapist to do correctly, and reducing strains on the pelvic floor by, for example, losing weight, can help manage genital prolapse. A pessary, a small device inserted into the vagina to reinforce the pelvic wall near the upper vagina, can also be inserted by a doctor as a short- or long-term solution. In some cases, the patient needs surgery to remedy the symptoms of prolapse and regain sexual, bladder, and bowel function. Some surgeries may include removal of the uterus, or hysterectomy, in women with uterine prolapse who no longer want to bear children, vaginal vault repair, and vaginal repair.