Category Archive Pregnancy & Mom Care

Vaginal prolapse is a condition where the vagina slips out of position. This is more common in women who have had multiple vaginal deliveries during childbirth, have gone through menopause, are smokers or are overweight. The chances of developing a prolapse also increase as you age.

Muscles, ligaments and skin, in and around the vagina, support and hold the female pelvic organs and tissues in place by acting as a hammock. However, pregnancy, childbirth, aging, and menopause, all contribute to the stretching and weakening of these pelvic floor muscles. The result can be a vaginal prolapse – where the pelvic organs, such as the uterus, rectum, bladder, urethra, small bowel, or even the vagina itself, fall out of their normal position. As a vaginal prolapse usually involves the vagina, plus another organ, it is often referred to as a Pelvic Organ Prolapse (POP).

Around 40% of us will be affected by a vaginal prolapse by the time we reach our 60’s, and this figure rises to 50% of us over 50. Although not life-threatening, it can cause severe pain and discomfort, especially in later stages if the prolapse becomes exposed outside of your vagina. So read on to learn about the causes, treatments and preventable measures.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to associated nerves – increasing the risk of a prolapse reoccurring. So avoid unnecessary delays and speak to your doctor if you have any concerns.

Types of Vaginal Prolapse

There are many different types of pelvic organ prolapse, each one has a different name depending on the pelvic organ affected:

• Rectocele prolapse – A prolapse of the back wall of the vagina (the rectovaginal fascia). This occurs when the rectal wall pushes against the vaginal wall, creating a bulge into the vagina. The effects of this bulge may be more noticeable during a bowel movement.
• Cystocele or bladder prolapse – When the front wall of the vagina weakens and allows the bladder to protrude into the vagina. If the urethra is also affected, it is called a urethrocele.
• Enterocele or small bowel prolapse – Also known as a herniated small bowel, this occurs when the upper vaginal supporting muscle becomes weakened. Resulting in the front and back walls of the vagina to separate, allowing the small intestines to push against the vaginal walls.
• Uterine prolapse – Weakening of the uterosacral ligaments at the top of the vagina can cause the uterus to fall and move downwards. Often, during a prolapsed uterus, both the front and back walls of the vagina start to weaken as well.
• Vaginal vault prolapse – Around 15% of women who have had a hysterectomy (complete removal of the womb and cervix) suffer a vaginal vault prolapse. The uterus provides support for the top of the vagina, if it is no longer there then the top of the vagina can gradually fall towards the vaginal opening and the vaginal walls weaken. Eventually, the top of the vagina can protrude out through the opening of the vagina.

Stage

There are four main stages of pelvic organ prolapse, as graded using the Pelvic Organ Prolapse Quantification System (POP-Q). The example organ used here is the uterus:

• First stage uterine prolapse – The uterus drops into the lower part of the vagina but cannot be seen from outside of the vagina.
• Second stage uterine prolapse – The uterus drops as far as the opening of the vagina but is still not visible from the outside.
• Third stage uterine prolapse – The cervix, the area between the opening of the uterus and the top of the vagina, is pushed to the outside of the vagina by the collapsing uterus.
• Fourth stage uterine prolapse – The entire uterus and cervix has dropped so low that it has fallen out of the vagina and is entirely visible from the outside. This is known as a ‘complete prolapse’ or procidentia.

Causes of Vaginal Prolapse

There are a few risk factors that may lead to you experiencing a vaginal or pelvic organ prolapse:

• Pregnancy – Around 50% of women who have carried a baby to full term will experience some kind of vaginal prolapse. This is in part due to the extra weight that the baby adds to the pelvic area, which can weaken the pelvic floor muscles. It is also thought to be caused by pregnancy hormones allowing vaginal tissues to stretch beyond their rebound limits. Multiple pregnancies will further increase your risk.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse. Mothers who have delivered four babies vaginally are at 12 times greater risk than women who have not given birth vaginally.
• Menopause – The change in hormones you experience during this time of your life, particularly the drop in estrogen, can cause your pelvic floor muscles to weaken. Effects can be worsened by the general loss of muscle tone associated with aging.
• Bodyweight – Being overweight or obese can increase your chances of suffering a pelvic organ prolapse due to the weight on your pelvic area causing strain.
• Genetics – If a family member has suffered a vaginal prolapse, then there may be a genetic reason that puts you at an increased risk.
• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smoker’s cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Heavy lifting – Repetitive heavy lifting, and lifting incorrectly, increases the pressure put on the pelvic floor.
• Strenuous activity – Heavy, high impact exercises such as running or plyometric training (jump training) can cause the pelvic floor muscles to weaken.
• Previous pelvic surgeries – A hysterectomy or previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Pelvic conditions – Heavy fibroids or a tumor somewhere in your pelvis can add weight to the area and weaken the pelvic floor muscles.
• Hysterectomy – Up to 40% of women who have had a hysterectomy (the complete removal of the womb and cervix) suffer a vaginal vault prolapse. The uterus provides support for the top of the vagina, if it is no longer there, then the top of the vagina can gradually fall towards the vaginal opening and the vaginal walls weaken.

Symptoms of Vaginal Prolapse

If you’re developing a vaginal or pelvic organ prolapse, then you may notice an odd feeling inside your vagina, like there’s something inside that is falling out. But it’s important to not feel embarrassed and speak to your doctor. In the early stages of pelvic organ prolapse, you may have no symptoms at all and it, therefore, may be diagnosed during a routine examination, such as a smear test.

As a prolapse advances, you may experience some or all of the following complaints:

• a feeling of pressure inside the vagina, especially when sitting down
• a dragging feeling inside the vagina, and/or feeling that something is going to fall out
• vaginal bleeding, outside of menstruation
• an excessively widened vagina, so much so that tampons don’t stay in place
• noticeable tissue protruding from the vagina, that may also be painful and bleed
• discomfort or pain during sex
• loss of feeling or ‘tightness’ when having sex
• pelvic or lower back pain
• pain that reduces when you lay down and increases when you stand for a long time
• persistent or frequent urinary tract infections (cystitis)
• urinary stress incontinence – the inability to hold in urine when you cough, sneeze, laugh, exercise or lift heavy objects
• a frequent need to urinate
• difficulty passing urine
• difficulty having a bowel movement – constipation and a feeling of not having fully emptied the bowel

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide which course of treatment is best for you.

Diagnosis of Pelvic Organ Prolapse

• Plain Films – Plain films are usually not appropriate for the evaluation of pelvic prolapse.[rx] Barium defecography is in use at some places as a part of the assessment of pelvic floor dysfunctions, however, with the advent of newer and non-ionizing radiation imaging techniques like MR defecography, barium defecography has become largely obsolete.
• Computed Tomography – Due to concern for radiation exposure and availability of MRI, which provides a better soft-tissue resolution, computed tomography (CT) is usually not appropriate for the evaluation of pelvic prolapse; however, one should look on the sagittal abdomen and pelvis images for a hint of pelvic floor prolapse by drawing a pubococcygeal line and see for overt prolapse and then recommend a dynamic MRI pelvis (MR Defecogram) for further evaluation.[rx]
• Magnetic Resonance – Dynamic magnetic resonance imaging (MRI) provides an accurate assessment of pelvic prolapse. MRI provides a better anatomic detail compared to the transtibial ultrasound and is also useful as a preoperative tool. Furthermore, the MRI examination does not require bowel preparation and does not involve sensitive pelvic exposure. Despite its benefits, the MRI is not widely available, expensive, and contraindicated in patients with MRI incompatible devices or hardware.
• Ultrasonography – Translabial ultrasound is a relatively inexpensive way of evaluating pelvic prolapse and is widely available. Besides, the ultrasound does not produce ionizing radiation and allows dynamic evaluation of the pelvic floor. However, the diagnostic quality of the ultrasound exam depends on the sonographer’s skill level and the interpreting radiologist’s familiarity with the examination.
• Nuclear Medicine – Nuclear medicine studies are usually not appropriate for the evaluation of pelvic prolapse.[rx]
• Angiography – Angiography is usually not appropriate for the evaluation of pelvic prolapse.[rx]

Treatments of Vaginal Prolapse

If you’re suffering from vaginal prolapse, speak to your doctor about what treatments may work for you. There are numerous different vaginal prolapse treatments that work and depend on your personal circumstances. Targeted pelvic floor muscle exercises are a popular choice for seeing a quick and effective improvement in your prolapse.

Surgery is considered as an option only when symptoms are severe and cannot be treated through other means, as there is a risk of further damage in the case of complications. Non-surgical treatments are also preferred when future children are desired, which can reduce the success of previous surgical procedures:

• Pelvic floor exercises – These exercises help to strengthen the pelvic floor. Used in conjunction with an electronic pelvic toner, they could make all the difference.
• Lifestyle treatments – You may be surprised how much difference losing weight, avoiding constipation, lifting properly, exercising differently, or giving up smoking can make.
• Hormone treatment – Hormone supplements and topical estrogen creams can help boost the levels of the hormones you may be lacking through menopause or age that weaken the pelvic floor.
• Wearing a vaginal pessary – A vaginal pessary will help to better support a pelvic organ prolapse. It’s a small device, usually made from silicone, that is placed inside the vagina to help support the vaginal wall and prevent other pelvic organs from collapsing further into it. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women. Your doctor can help you find the right one and help you change the pessary every four to six months. This is commonly the favored treatment for those unable to undergo surgery due to other medical conditions or those wishing to have children in the future. Pessaries can support even very severe prolapses..
• vaginal pessaries – A pessary is a removable device inserted into the vagina to support the pelvic organs. Pessaries come in many different shapes and sizes. Pessaries are often the first treatment your doctor will try. Certain types of pessaries can treat both pelvic organ prolapse and urinary incontinence. A device made of rubber (latex) or silicone is inserted into the vagina and left in place to support the vaginal walls and pelvic organs. Vaginal pessaries allow you to get pregnant in the future. They can be used to ease the symptoms of moderate or severe prolapses and are a good option if you cannot or would prefer not to have surgery. Vaginal pessaries come in different shapes and sizes depending on your need. The most common is called a ring pessary.
• Pelvic floor muscle therapy – Your doctor may show you how to do pelvic floor exercises or refer you to a physical therapist to do exercises to help strengthen the pelvic floor muscles. Pelvic floor muscle exercises can also help women who have pelvic organ prolapse as well as urinary incontinence.
• Changing eating habits – If you have bowel problems, your doctor may recommend eating more foods with fiber. Fiber helps prevent constipation and straining during bowel movements.
• Pelvic floor exercises – Doing pelvic floor exercises will strengthen your pelvic floor muscles and may well relieve your symptoms. A GP or specialist may recommend a program of supervised pelvic floor muscle training for at least 16 weeks before you move on to other treatments or surgery.
• Rubber or silicone rubber device – fitted to the patient which is inserted into the vagina and may be retained for up to several months. Pessaries are a good choice of treatment for women who wish to maintain fertility, are poor surgical candidates, or who may not be able to attend physical therapy.^[rx] Pessaries require a provider to fit the device, but most can be removed, cleaned, and replaced by the woman herself. Pessaries should be offered to women considering surgery as a non-surgical alternative.
• Osteogen Therapy – If you have a mild prolapse and have been through menopause, your doctor may recommend treatment with estrogen to ease some of your symptoms, such as vaginal dryness or discomfort during sex. Oestrogen is available as:
  • a cream you apply to your vagina
  • a tablet you insert into your vagina
  • an estrogen-releasing vaginal ringHormone (estrogen) treatment

SURGICAL TREATMENT

While reconstructive surgery for POP is an option, it must be noted that there is a 30% recurrence rate for women choosing this route. Prolapse repairs can be done transvaginally, abdominally, laparoscopically, and/or robotically (when a scope is placed through the belly button). Ultimately, the purpose of the surgery is to correct the anatomy as well as provide better bowel, bladder, and vaginal function.

• Cystocele Repair – This surgery repairs a prolapsed bladder or urethra (urethrocele)
• Hysterectomy – This is complete removal of the uterus.
• Rectocele Repair – A rectocele repairs the fallen rectum and small bowel (enterocele).
• Vaginal Vault Suspension – Most commonly a laparoscopic procedure to repair the vaginal wall
• Vaginal Obliteration – Closure of the vagina
  Fixation or suspension – using your own tissues (uterosacral ligament suspension and sacrospinous fixation)—Also called “native tissue repair,” this is used to treat uterine or vaginal vault prolapse. It is performed through the vagina. The prolapsed part is attached with stitches to a ligament or to a muscle in the pelvis. A procedure to prevent urinary incontinence may be done at the same time.
• Hysterectomy – This is the complete removal of the uterus and is often performed in a uterine prolapse emergency or when a uterine prolapse is severe. This can be performed through the vagina, or through the abdomen. The vaginal walls are then attached to healthy ligaments as support for the other organs. This surgery prevents any future pregnancies and is often followed by further pelvic organ prolapses as the uterus is no longer there to support the other pelvic organs, so it is important to consider other options before choosing a hysterectomy.
• Colporrhaphy—Used to treat prolapse of the anterior (front) wall of the vagina and prolapse of the posterior (back) wall of the vagina. This type of surgery is performed through the vagina. Stitches are used to strengthen the vagina so that it once again supports the bladder or the rectum.
• Sacrocolpopexy—Used to treat vaginal vault prolapse and enterocele. It can be done with an abdominal incision or with laparoscopy. Surgical mesh is attached to the front and back walls of the vagina and then to the sacrum (tail bone). This lifts the vagina back into place.
• Sacrohysteropexy—Used to treat uterine prolapse when a woman does not want a hysterectomy. Surgical mesh is attached to the cervix and then to the sacrum, lifting the uterus back into place.
• Surgery using vaginally placed mesh—Used to treat all types of prolapse. Can be used in women whose own tissues are not strong enough for native tissue repair. Vaginally placed mesh has a significant risk of severe complications, including mesh erosion, pain, infection, and bladder or bowel injury. This type of surgery should be reserved for women in whom the benefits may justify the risks.
• Uterine suspension sling / a uterine or vault suspension (without support) – These surgeries all include a repair where the prolapsed organs are stitched back into place. Most procedures use stitches that dissolve over 4-6 months. However, some procedures, such as the uterine suspension sling, use a synthetic mesh lining for additional support. Using a mesh lining is currently only recommended within the context of research, as current evidence into the safety of the procedure is insufficient.
• Sacrocolpopexy or sacrospinous fixation – Often recommended when your condition is the result of a previous hysterectomy. A sacrospinous fixation involves the top of the vagina being stitched to the sacrospinous ligament, which is near the tail bone, for support. This procedure has a 70-80% success rate.
• Obliterative surgery – This surgery can be considered an extreme option. The surgeon will narrow or close off the vagina to prevent prolapsed organs from prolapsing outside the vagina. This prevents sex intercourse and vaginal childbirth.

or

• Anterior (front) vaginal wall repair – Also known as anterior colporrhaphy, this is a treatment option for women whose bladder has slipped down and is pushing against the front wall of the vagina (a cystocele). It involves strengthening and tightening the connective tissue between the bladder and vagina in order to lift and support the bladder.
• Posterior (back) vaginal wall repair – Also known as posterior colporrhaphy, this treatment is considered for women who have a rectocele. This is a prolapse that causes the lower part of the bowel (the rectum) to push against the back wall of the vagina. The surgery involves strengthening and tightening the connective tissue between the vagina and rectum in order to lift and support this part of the bowel.
• Sacrocolpopexy and sacrohysteropexy – These procedures aim to correct prolapse in the middle of the pelvic floor – for instance, if the uterus (womb) has dropped down. Sacrocolpopexy involves attaching the top of the vagina to the sacrum or coccyx (tailbone) using synthetic mesh. In sacrohysteropexy, the cervix is attached instead. The womb doesn’t have to be removed.
• Sacrospinous fixation – This is an alternative surgical approach to correcting prolapse in the middle of the pelvic floor. In order to lift the vagina back to a higher position, it is attached to ligaments in the pelvis.

Physiotherapy

Physical therapists play a major role in the nonsurgical management of POP. Along with pessary support, pelvic-floor muscle training (PFMT) is cited in highly credible reviews as a main nonsurgical option for women with POP.

For all the information re retraining, these muscles see the physiotherapy section of Pelvic Floor Dysfunction and Kegel’s Exercises

In a study by Panman et al in 2016, examining the two-year effects of pelvic floor muscle retraining, it was demonstrated that in women aged 55 and greater with symptomatic mild pelvic organ prolapse, pelvic floor muscle retraining results in a significant decrease in pelvic floor symptoms when compared to watchful waiting (note: statistically significant but below the minimal clinically important difference). Additionally, it was found that pelvic floor muscle retraining was more effective in women who experienced increased pelvic floor symptom distress at baseline. Conversely, the same study found no difference in sexual functioning, quality of life, the function of the pelvic floor muscles or degree of prolapse.

A randomized control trial compared the effect of intravaginal vibratory stimulation (IVVS) with intravaginal electrical stimulation (IVES) in women with pelvic floor dysfunctions, unable to voluntarily contract the pelvic floor muscles. The results showed improvement with both techniques, with IVVS superior to IVES in improving pelvic floor muscle strength.

Pelvic floor muscle retraining included: (Kegel exercises diagram in illustration)

• Explanation and description of the pelvic floor 
• Instruction regarding how to contract and relax pelvic floor muscles 
  • If unable to perform this task, use feedback through digital palpation 
  • If insufficient control demonstrated, use my feedback or electrical stimulation 
• General exercise program provided, subsequently modified for individual needs 
• Taught correct technique for contracting pelvic floor muscles before and during increases in abdominal pressure 
• Received information about washroom habits and lifestyle ^[rx]
• If pelvic floor muscles were overactive, the focus was on relaxation rather than contraction 
• Face-to-face contact with a physiotherapist as well as encouragement to maintain practice at home 3-5 times per week, 2-3 times per day.

How Can I Prevent a Vaginal Prolapse?

If you think you might be at risk of vaginal prolapse, there are steps you can take to prevent one:

• Kegel exercises – Also known as pelvic floor exercises, you can do them quickly and easily at any point in the day as no one will know you’re doing them. They help to strengthen the pelvic floor muscles. You can make them even more effective by using an electronic toner.
• Maintain your weight – Making sure you stick to a healthy weight will put less pressure on your pelvic floor muscles, giving you more chance of keeping them strong. The National Institute for Heath and Care Excellence (NICE) recommends keeping your BMI under 30.
• Avoiding constipation – Eating a high fiber diet of fruits, vegetables, and wholegrain cereals will help your bowels stay regular, as will drinking plenty of water.
• Avoid straining on the toilet – Straining on the toilet puts unnecessary pressure on the pelvic floor muscles. Using a toilet stool when you pass a bowel movement will help avoid straining as it puts your body in the optimum position for fully emptying your bowels.
• Lift heavyweights (and children) safely – Lifting correctly will make all the difference to not only your back but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
• Avoid too much high impact exercise – High impact exercises are great for overall health. But if you’re worried about a prolapse, then gentler, lower impact exercise like swimming may be better for you.
• Treat that cough – Persistent heavy coughing can cause a weakening in the pelvic floor muscles that may not become apparent straight away. Get medical help for a cough that lasts longer than a week or so.

Even if you’re young, of a healthy weight and have no plans to have a baby any time soon, these steps are still worth taking.

References

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Uterine prolapse is when the uterus descends toward or into the vagina. It happens when the pelvic floor muscles and ligaments become weak and are no longer able to support the uterus.

The uterus is a muscular ‘sac’ that stretches and bends with the demands of pregnancy and childbirth. It sits inside the pelvic cavity and is held in place by a combination of the other organs in the pelvis and the pelvic floor muscles and ligaments. When the pelvic floor muscles are weak they loosen and stretch out of place, no longer acting as support for the pelvic organs. In the case of uterine prolapse, this can allow the uterus to droop and bulge into the vaginal space as an incomplete uterine prolapse. If untreated, the uterus can drop so low that it uncomfortably, and often painfully, protrudes outside the vagina as a complete uterine prolapse, also known as procidentia.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to associated nerves – increasing the risk of the prolapse reoccurring. So avoid unnecessary delays and speak to your doctor if you have any concerns.

Stage Uterine Prolapse

Uterine prolapse can be incomplete or complete, depending on how far it has fallen into the vagina, away from its natural position:

• Incomplete uterine prolapse – The uterus has partially dropped into the vagina and the tissue isn’t visible from the outside.
• Complete uterine prolapse – When the uterus drops down into the vagina sufficiently that some tissue of the uterus is visible on the outside of the vagina. This is also known as procidentia.

Uterine prolapse can cause other organs within the pelvic cavity to prolapse, as it adds weight to the already weakened pelvic floor muscles:

• An anterior vaginal prolapse or cystocele – This is a type of bladder prolapse when the bladder bulges into the vagina from the front (anterior) vaginal wall. This generally happens when tissues between the vagina and the bladder are weak.
• Posterior vaginal prolapse or rectocele – A rectocele prolapse occurs when the tissues at the back (posterior) of the vagina, between the vagina and the rectum, weaken. The rectum is forced downwards and bulges into the vagina.

Both of these secondary prolapses can be of varying degrees of severity, remaining within the vagina, or protruding from it on the outside.

A very severe uterine prolapse can also cause part of the vaginal wall to collapse on itself, and end up protruding from the vagina. It isn’t often that a uterine prolapse occurs on its own, it’s usually as part of another organ prolapsing into it and taking the vaginal walls with it.

Causes of Uterine Prolapse

Here is a list of the possible causes of a prolapsed uterus. Having these does not mean you will definitely go on to develop a prolapsed uterus, they are just risk factors:

• Pregnancy – During pregnancy the body changes in many ways. The uterus can stretch well beyond its rebound ability, leaving it loose. And the extra weight of the baby on the pelvic floor can weaken the muscles.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse. Mothers of four babies, all delivered vaginally, are at 12 times greater risk than women who have not given birth vaginally.
• Menopause – The change in hormones you experience during this time of your life, particularly the drop in estrogen, can cause your pelvic floor muscles to weaken. Effects can be worsened by the general loss of muscle tone associated with aging.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smoker’s cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Bodyweight – Being overweight or obese can increase your chances of suffering a prolapse due to the weight on your pelvic area.
• Heavy lifting – Repeated and incorrect heavy lifting puts extra pressure on your pelvic floor.
• Strenuous activity – Heavy, high impact exercises such as running or plyometric training (jump training) can cause the pelvic floor muscles to weaken.
• Previous pelvic surgeries – A hysterectomy or previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Genetics – A family history of prolapse can suggest you are at a higher risk.

Symptoms of Uterine Prolapse

If you’re developing a uterine prolapse, then you may notice an odd feeling inside your vagina, like there’s something inside that is falling out. At that stage, it likely that you also experience a number of the other symptoms listed below, and as a prolapse advances, you will likely experience even more of the following complaints:

• a feeling of pressure inside the pelvic area, especially when sitting down
• a dragging feeling inside the pelvic area, and/or feeling that something is going to fall out
• feeling like you are sitting on a small ball
• vaginal bleeding, outside of your menstruation
• noticeable tissue protruding from the vagina, that may also be painful and bleed
• discomfort or pain during sex
• loss of feeling or tightness when having sex
• pelvic or lower back pain
• persistent or frequent urinary tract and bladder infections (cystitis)
• urinary stress incontinence – the inability to hold in urine when you cough, sneeze, laugh, exercise or lift heavy objects
• difficulty or pain passing urine
• difficulty or pain having a bowel movement – constipation and a feeling of not having fully emptied your bowel
• pain or difficulty walking normally
• symptoms that get progressively worse as the day goes on

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide which course of treatment is best for you.

Diagnosis of Uterine Prolapse

• Plain Films – Plain films are usually not appropriate for the evaluation of pelvic prolapse.[rx] Barium defecography is in use at some places as a part of the assessment of pelvic floor dysfunctions, however, with the advent of newer and non-ionizing radiation imaging techniques like MR defecography, barium defecography has become largely obsolete.
• Computed Tomography – Due to concern for radiation exposure and availability of MRI, which provides a better soft-tissue resolution, computed tomography (CT) is usually not appropriate for the evaluation of pelvic prolapse; however, one should look on the sagittal abdomen and pelvis images for a hint of pelvic floor prolapse by drawing a pubococcygeal line and see for overt prolapse and then recommend a dynamic MRI pelvis (MR Defecogram) for further evaluation.[rx]
• Magnetic Resonance – Dynamic magnetic resonance imaging (MRI) provides an accurate assessment of pelvic prolapse. MRI provides a better anatomic detail compared to the transtibial ultrasound and is also useful as a preoperative tool. Furthermore, the MRI examination does not require bowel preparation and does not involve sensitive pelvic exposure. Despite its benefits, the MRI is not widely available, expensive, and contraindicated in patients with MRI incompatible devices or hardware.
• Ultrasonography – Translabial ultrasound is a relatively inexpensive way of evaluating pelvic prolapse and is widely available. Besides, the ultrasound does not produce ionizing radiation and allows dynamic evaluation of the pelvic floor. However, the diagnostic quality of the ultrasound exam depends on the sonographer’s skill level and the interpreting radiologist’s familiarity with the examination.
• Nuclear Medicine – Nuclear medicine studies are usually not appropriate for the evaluation of pelvic prolapse.[rx]
• Angiography – Angiography is usually not appropriate for the evaluation of pelvic prolapse.[rx]

Treatment of  Uterine Prolapse

Non-Pharmacological

• Kegel exercises – These are also known as pelvic floor exercises. You can do them quickly and easily, at any time of day as no one will know you’re doing them. They help to strengthen the pelvic floor muscles. You can make them even more effective by using an electronic pelvic toner.
• Maintain your weight – Making sure you stick to a healthy weight will put less pressure on your pelvic floor muscles, giving you more chance of keeping them strong. The National Institute for Heath and Care Excellence (NICE) recommends keeping your BMI under 30.
• Avoiding constipation – Eating a high fiber diet of fruits, vegetables, and wholegrain cereals will help your bowels stay regular, as will drinking plenty of water.
• Avoid straining on the toilet – Straining on the toilet puts unnecessary pressure on the pelvic floor muscles. Using a toilet stool when you pass a bowel movement will help avoid straining as it puts your body in the optimum position for fully emptying your bowels.
• Lift heavyweights (and children) safely – Lifting correctly will make all the difference to not only your back but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
• Avoid too much high impact exercise – High impact exercises are great for overall health. But if you’re worried about uterine prolapse, then gentler, lower impact exercise will be better for you.
• Treat that cough – Persistent heavy coughing can cause a weakening in the pelvic floor muscles that may not become apparent straight away. Get medical help for a cough that lasts longer than a week.

If you have the beginnings of uterine prolapse, then adopting the preventative steps listed above may be all you need to treat it, or at least stop it from getting worse. Targeted pelvic floor muscle exercises are a popular choice for seeing a quick and effective improvement in your prolapse.

Your doctor may also discuss the following treatments, depending on your personal circumstances:

• Hormone replacement therapy – If you’re menopausal, your doctor may suggest estrogen replacement therapy or creams to help top up your estrogen levels which in turn may help strengthen your pelvic floor. This can be in the form of cream you apply to your vagina or a tablet that you would insert. This treatment is often recommended for mild uterine prolapses.
• Uterine prolapse pessaries – A vaginal pessary will help to better support even severe uterine prolapses. It’s a small device, usually made from silicone, that is placed inside the vagina to help support the vaginal wall and prevent other pelvic organs from collapsing further into it. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women. Your doctor can help you find the right one and help you change the pessary every four to six months. This is commonly the favored treatment for those unable to undergo surgery due to other medical conditions or those wishing to have children in the future. They can also be used whilst you strengthen your pelvic floor.

Surgery

Surgery is considered as an option only when symptoms are severe and cannot be treated through other means, as there is a risk of further damage in the case of complications. Non-surgical treatments are also preferred when future children are desired, which can reduce the success of previous surgical procedures. If you are advised to have a surgical intervention for your uterine prolapse, there are several surgical procedures currently available and may be completed in conjunction to repair all prolapses you are experiencing:

• Uterine suspension surgery – Your surgeon will move your uterus back to where it should be, then use either your own pelvic ligaments or a biological or synthetic mesh lining for additional support. Using a mesh lining is currently only recommended within the context of research, as current evidence into the safety of the procedure is insufficient. This surgery is usually completed through the vagina but maybe through the abdomen to avoid damaging the vagina.
• Laparoscopic suture hysteropexy (ligament) surgery – Through a laparoscopy (keyhole surgery), the damaged pelvic (uterosacral) ligaments can be repaired by connecting the strong top and bottom of the ligaments, reducing the pressure on the weakened middle. This surgery preserves the uterus and allows the patient to become pregnant. This is a relatively new procedure, therefore there are not yet any long term studies into its success.
• Vaginal hysteropexy (ligament) surgery – As above, this surgery looks at connecting the strong sections of the ligaments. It is completed through the vagina and into the abdomen – therefore leaves no scarring. This method of accessing the abdomen is favoured where other prolapses are due to be repaired at the same time.
• Hysterectomy – This is the complete removal of the uterus and is often performed in a uterine prolapse emergency or when a uterine prolapse is severe. This can be performed through the vagina, or through the abdomen. The vaginal walls are then attached to healthy ligaments as support for the other organs. This surgery prevents any future pregnancies and is often followed by further pelvic organ prolapses as the uterus is no longer there to support the other pelvic organs, so it is important to consider other options before choosing a hysterectomy.

References

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Uterine Prolapse at a Young Age Prolapse After Childbirth – What To Know, How To Do Prolapsed Uterine Bladder – Causes, Symptoms, Treatment Vaginal Vault Prolapse – Causes, Symptoms, Treatment What is the Best Exercise for Uterine Prolapse Bladder Prolapse – Causes, Symptoms, Treatment Vaginal Prolapse – Causes, Symptoms, Diagnosis, Treatment Enterocele Prolapse – Causes, Symptoms, Treatment Prolapse Urethrocele – Causes, Symptoms, Treatment Cystocele Prolapse – Causes, Symptoms, Treatment Core Strengthening Exercise; Exercise for Uterine Prolapse Rectal Prolapse – Causes, Symptoms, Diagnosis, Treatment

Vaginal Vault Prolapse/A vaginal vault prolapse is the name for a condition experienced in women when the top part of the vaginal wall loses its strength and begins to droop downwards. As the top of the vagina descends, it prolapses (bulges) into the vaginal canal and can even become visible from the outside of the vagina. A vaginal vault prolapse occurs as a result of weak pelvic floor muscles.

A vaginal vault prolapse can occur on its own. However, 72% of women suffer one or more other pelvic organ prolapses at the same time as a vaginal vault prolapse due to the loss of support that the vagina normally gives.

A vaginal vault prolapse is common in women who have undergone hysterectomy surgery to completely remove the uterus. The uterus usually sits above the vagina, linked by a piece of tissue called the cervix. If it is removed there is no longer anything there to anchor the top of the vagina in place, often allowing it to prolapse.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to associated nerves – increasing the risk of the prolapse reoccurring. To avoid unnecessary delays and speak to your doctor if you have any concerns.

Stages of  Vaginal Vault Prolapse

There are four main stages of pelvic organ prolapse, as graded using the Pelvic Organ Prolapse Quantification System (POP-Q). Some women don’t experience any symptoms at all from a vaginal vault prolapse and are only diagnosed as a result of having a smear test or other routine pelvic examination. Others experience mild or moderate symptoms, and others experience debilitating and severe symptoms. As many as half of all women who have had children and/or are over the age of 60 will develop a degree of vaginal vault prolapse.

Doctors use the following system to grade the severity of a vaginal vault prolapse:

• Stage 1 – The vaginal wall prolapse and symptoms are very minor, and the pelvic organs are still generally well supported.
• Stage 2 – The vaginal wall has begun to droop, but it is not visible from the outside of the vagina. Symptoms are mild.
• Stage 3 – The top of the vagina has drooped to the degree that it is sometimes visible from the outside of the vagina when coughing, laughing, lifting or straining. Symptoms are moderate.
• Stage 4 – The vagina has prolapsed so much that it is completely and permanently visible on the outside of the vagina. Symptoms are now severe.

Studies suggest that a vaginal vault prolapse is always accompanied by a degree of both cystocele and rectocele prolapses due to the loss of support for these organs. These conditions have similar treatments to a vaginal vault prolapse, so can often be treated collectively.

Causes of Vaginal Vault Prolapse

As with all pelvic organ prolapses, the usual cause of a vaginal vault prolapse is weak pelvic floor muscles. This weakening causes the organs to begin to drop down and eventually prolapse. And as mentioned above, the most likely cause of this weakening is having a hysterectomy:

• Hysterectomy – Up to 40% of women who have had a hysterectomy (the complete removal of the womb and cervix) suffer a vaginal vault prolapse. The uterus provides support for the top of the vagina, if it is no longer there, then the top of the vagina can gradually fall towards the vaginal opening and the vaginal walls weaken.
• Pregnancy – Around 50% of women who have carried a baby to full term will experience some kind of vaginal prolapse. This is in part due to the extra weight that the baby adds to the pelvic area, which can weaken the pelvic floor muscles. It is also thought to be caused by pregnancy hormones allowing vaginal tissues to stretch beyond their rebound limits. Multiple pregnancies will further increase your risk.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse. Mothers of four babies, all delivered vaginally, are at 12 times greater risk than women who have not given birth vaginally.
• Bodyweight – Being overweight or obese can increase your chances of suffering a pelvic organ prolapse due to the weight on your pelvic area.
• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smoker’s cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Heavy lifting – Repetitive heavy lifting, and lifting incorrectly, increases the pressure put on the pelvic floor.
• Strenuous activity – Heavy, high impact exercises such as running or plyometric training (jump training) can cause the pelvic floor muscles to weaken.
• Previous pelvic surgeries – A hysterectomy or previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Pelvic conditions – Heavy fibroids or a tumor somewhere in your pelvis can add weight to the area and weaken the pelvic floor muscles.

A vaginal vault prolapse can also be caused by having another pelvic organ prolapse.

Symptoms of  Vaginal Vault Prolapse

You may experience some or all the following symptoms if you have a vaginal vault prolapse. Having some or all of them doesn’t guarantee that you have a vaginal vault prolapse, they are just risk factors.

• a heaviness, pressure or dragging sensation in the pelvic area
• pain in the lower back
• bleeding from the vagina that isn’t associated with your period
• urinary stress incontinence – a dribble of urine if you cough, laugh, sneeze, run or jump
• urinary incontinence – the inability to hold in urine at all
• the need to urinate more frequently
• the need to urinate more urgently
• difficulty urinating
• constipation
• a noticeable bulge inside the vagina
• a noticeably larger, or gaping vagina – so much so that a tampon cannot stay in place
• difficulty and pain when having sex
• tissue that protrudes from the vagina and is visible from the outside of the body
• symptoms and pain that is made worse by standing or walking

If you’re experiencing symptoms, make an appointment to see your doctor. Pelvic organ prolapses can be embarrassing, but it might be comforting to know that they are also very common.

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide on which course of treatment is best for you to meet your expectations of health and lifestyle.

Diagnosis of Vaginal Vault Prolapse

• Plain Films – Plain films are usually not appropriate for the evaluation of pelvic prolapse.[rx] Barium defecography is in use at some places as a part of the assessment of pelvic floor dysfunctions, however, with the advent of newer and non-ionizing radiation imaging techniques like MR defecography, barium defecography has become largely obsolete.
• Computed Tomography – Due to concern for radiation exposure and availability of MRI, which provides a better soft-tissue resolution, computed tomography (CT) is usually not appropriate for the evaluation of pelvic prolapse; however, one should look on the sagittal abdomen and pelvis images for a hint of pelvic floor prolapse by drawing a pubococcygeal line and see for overt prolapse and then recommend a dynamic MRI pelvis (MR Defecogram) for further evaluation.[rx]
• Magnetic Resonance – Dynamic magnetic resonance imaging (MRI) provides an accurate assessment of pelvic prolapse. MRI provides a better anatomic detail compared to the transtibial ultrasound and is also useful as a preoperative tool. Furthermore, the MRI examination does not require bowel preparation and does not involve sensitive pelvic exposure. Despite its benefits, the MRI is not widely available, expensive, and contraindicated in patients with MRI incompatible devices or hardware.
• Ultrasonography – Translabial ultrasound is a relatively inexpensive way of evaluating pelvic prolapse and is widely available. Besides, the ultrasound does not produce ionizing radiation and allows dynamic evaluation of the pelvic floor. However, the diagnostic quality of the ultrasound exam depends on the sonographer’s skill level and the interpreting radiologist’s familiarity with the examination.
• Nuclear Medicine – Nuclear medicine studies are usually not appropriate for the evaluation of pelvic prolapse.[rx]
• Angiography – Angiography is usually not appropriate for the evaluation of pelvic prolapse.[rx]

Treatments of Vaginal Vault Prolapse

• Maintain your weight – Making sure you stick to a healthy weight will put less pressure on your pelvic floor muscles, giving you more chance of keeping them strong. The National Institute for Heath and Care Excellence (NICE) recommends keeping your BMI under 30.
• Avoiding constipation – Eating a high fiber diet of fruits, vegetables, and wholegrain cereals will help your bowels stay regular, as will drinking plenty of water.
• Avoid straining on the toilet – Straining on the toilet puts unnecessary pressure on the pelvic floor muscles. Using a toilet stool when you pass a bowel movement will help avoid straining as it puts your body in the optimum position for fully emptying your bowels.
• Lift heavyweights (and children) safely – Lifting correctly will make all the difference to not only your back but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
• Avoid too much high impact exercise – High impact exercises are great for overall health. But if you’re worried about a prolapse, then gentler, lower impact exercise like swimming may be better for you.
• Treat that cough – Persistent heavy coughing can cause a weakening in the pelvic floor muscles that may not become apparent straight away. Get medical help for a cough that lasts longer than a week or so.
• Kegel exercises – Performing daily pelvic floor exercises could be all you need to keep your vaginal vault prolapse under control. Using an electronic pelvic toner such as the Kegel8 Ultra 20 Pelvic Toner will make the exercises more beneficial. In the circumstance of non-surgical treatments not fully relieving your symptoms and they remain severe, you may be advised to have a surgical intervention for your vaginal vault prolapse. There are several surgeries available. The surgery your surgeon will select will be based on you age, health, lifestyle, sexual activity, and their skill set. The procedure may be completed in conjunction with others, to repair all prolapses you are experiencing at once:
• Vaginal vault prolapse repair surgeries – The two most common vaginal vault prolapse repair surgeries are abdominal sacrocolpopexy surgery (success rate of close to 90%) and sacrospinous fixation surgery. During these procedures, the top part of the vagina is moved and surgically attached to the lower abdominal wall, the lower back or the ligaments of the pelvis. Your surgeon will do this via deep surgical stitches. For those with a strong pelvic floor, the surgery can be completed under general anesthetic through the vagina. However, surgeries undertaken through the vagina are associated with loss of sensation and a high rate of additional complications following the surgery due to the tissue damage. Therefore it is most often performed through the abdomen, either during open or laparoscopy (keyhole) surgery. Using a synthetic mesh lining as additional support is currently only recommended within the context of research, as current evidence into the safety of the procedure is insufficient.
• Other surgeries – Other surgeries include a uterosacral ligament suspension and iliococcygeal fixation. These are less common due to their higher risk of damage to the other pelvic organs and the higher skill set needed by your surgeon. However, they are associated with less risk to normal vaginal function so may be favored, where possible, for women who are sexually active.

How Long Does it Take to Recover from a Vaginal Vault Prolapse Surgery?

For the surgery you will have a catheter fitted, which will stay in place for a further 8 – 24 hours following the surgery. You may go home with the catheter and get it removed by a nurse at the follow-up appointment the next day. After the catheter is removed, you may notice some difference in your urine flow as a result of swelling.

20% of patients experience bright red bleeding from the vagina following a prolapse surgery involving mesh, this suggests the mesh is coming through into the vagina as you move. If this happens you need to treat it as an emergency and the exposed mesh will be removed during a second operation.

The usual recovery period for a vaginal vault prolapse surgery is around six weeks. During the first fortnight, you will likely feel discomfort and some pain in your buttocks, depending on the surgery undergone. You may also be prescribed medication and recommended activity to avoid developing deep vein thrombosis. Throughout the six week recovery, you will also likely experience bleeding and a creamy white discharge, which you can use pads (not tampons) to manage. You may be recommended to avoid driving, and some insurance companies may not even cover you during the first-fortnight post operation.

After the six weeks, most women can go about their daily business, and comfortably resume having sex. If, during the surgery, another prolapse was located or damage was done to the surrounding organs, the procedure may have been extended to incorporate these further repairs. This could result in a slightly longer recovery time.

References

People Also Reading

Vaginal Prolapse – Causes, Symptoms, Diagnosis, Treatment Your Sex Life After a Vaginal Prolapse What Is a Vaginal Prolapse Repair Surgery? Posterior Vaginal Prolapse – Causes, Symptoms, Treatment Prolapse After Childbirth – What To Know, How To Do Uterine Prolapse at a Young Age Uterine Prolapse – Causes, Symptoms, Treatment Enterocele Prolapse – Causes, Symptoms, Treatment Sigmoidocele – Causes, Symptoms, Treatment Bladder Prolapse – Causes, Symptoms, Treatment Prolapse Urethrocele – Causes, Symptoms, Treatment Pouch of Douglas Descent – Symptoms, Treatment

A bladder prolapse causes the pressure inside the bladder to increase, causing discomfort and urinary incontinence. We’ve all experienced what it feels like to have a full bladder, with nowhere to empty it, and how it no longer sits comfortably within the pelvis. Urinary incontinence can range from occasional stress urinary incontinence, where women may leak a small amount of urine if they cough or sneeze, to a more severe inability to hold in urine.

The bladder is a balloon-shaped, muscular bag that sits comfortably within the pelvis as it constantly fills with urine. The muscular front walls of the vagina (anterior walls) and the pelvic area help to support the bladder and hold it in place. If the muscles in the front wall of the vagina loosen and deteriorate too much, then a bladder prolapse can occur, where the bladder falls into the vagina.

Bladder prolapse is a common condition in women. It can be disruptive, embarrassing, and inconvenient, but it is treatable.

bladder are held in their normal positions just above the inside end of the vagina by a “hammock” made up of supportive muscles and ligaments. Wear and tear on these supportive structures in the pelvis can allow the bottom of the uterus, the floor of the bladder or both to sag through the muscle and ligament layers.

When this occurs, the uterus or bladder can create a bulge into the vagina. In severe cases, it is possible for the sagging uterus or bladder to work its way down far enough that the bulge can appear at the vagina’s opening or even protrude from the opening.

When the uterus sags downward, it is called uterine prolapse. When the bladder sags, it is called bladder prolapse, also known as a cystocele.

Types of Bladder Prolapse

Types of Bladder Prolapse Various stresses can cause the pelvic muscles and ligaments to weaken and lead to uterine or bladder prolapse. The most significant stress on these muscles and ligaments is childbirth. Women who have had multiple pregnancies and vaginal delivery are more likely to develop prolapse.

There are three different types of bladder prolapse, cystocele, urethrocele, and cystourethrocele. These can occur in isolation or together:

• Cystocele – The most common type of pelvic organ prolapse, when the whole bladder bulges or drops into the vagina. Cystocele is commonly associated with the prolapse of other organs within the pelvis.
• Urethrocele – When the tissues surrounding the urethra (the tube that carries urine from the bladder and out of the body) prolapse, or drop down into the vagina.
• Cystourethrocele – Both the bladder and the urethral tissues prolapse into the vagina together.

Stages of a Bladder Prolapse

Bladder prolapse is diagnosed by a doctor or surgeon, and can occur in three stages, or grades:

• Stage 1 – The bladder has dropped only a short distance into the vagina, and bladder prolapse symptoms are mild.
• Stage 2 – The bladder has dropped a further distance into the vagina and has reached the outer opening of the vagina. Bladder prolapse symptoms are moderate.
• Stage 3 – The bladder has dropped so sufficiently into the vagina, that it begins to protrude out through the outer opening of the vagina. Bladder prolapse symptoms become the most advanced they can get.

Causes of Bladder Prolapse

The bladder and/or the urethral tissue can prolapse into the vagina if the pelvic floor muscles are weakened. These can be weakened by several factors:

• Pregnancy – Extra weight on the pelvic floor can cause the muscles to weaken.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse. Mothers who deliver four babies vaginally are at 12 times greater risk than women who have not given birth vaginally.
• Menopause – The change in hormones you experience during this time of your life, particularly the drop in estrogen, can cause your pelvic floor muscles to weaken. Effects can be worsened by the general loss of muscle tone associated with aging.
• Bodyweight – Being overweight or obese can increase your chances of suffering a pelvic organ prolapse due to the weight on your pelvic area.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smoker’s cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Heavy lifting – Repeated and incorrect heavy lifting puts extra pressure on your pelvic floor.
• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Hysterectomy – Many women who have had a hysterectomy (the complete removal of the womb and cervix) suffer a secondary prolapse. The uterus provides support for the other pelvic organs, if it is no longer there, then the bladder can gradually fall towards the vaginal opening.
• Previous pelvic surgeries – A hysterectomy or previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Medical conditions – Medical conditions that weaken the pelvic floor muscles, such as joint hypermobility syndrome (the ability to maneuver joints into unusual positions).

Symptoms of Bladder Prolapse

There are many symptoms that accompany bladder prolapse. In the early stages of a prolapsed bladder, they may even be unnoticeable. The following warning signs are common and can be experienced as very mild to severe, you may also only experience a few of these symptoms:

• heaviness or a feeling of pressure in the vagina
• a feeling that there is something inside and/or falling out of the vagina
• visible tissue poking out from the vagina that is tender and/or bleeds
• a frequent urge and/or an urgent need to pass urine
• difficulty urinating, not feeling like your bladder has fully emptied after passing urine
• urinary incontinence – the inability to hold urine in when not on the toilet
• stress incontinence – passing small amounts of urine when coughing, sneezing, laughing, exercising or lifting heavyweight
• Nocturia – the medical term for getting up more than once during the night to pass urine
• discomfort and pain when urinating
• frequent bladder or urinary infections such as cystitis
• pain during sex
• pain in the lower back, pelvis or groin

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide which course of treatment is best for you.

or

Mild cases of bladder or uterine prolapse usually don’t cause any symptoms. A prolapse that is more advanced can cause any of the following symptoms:

• Discomfort in the vagina, pelvis, lower abdomen, groin or lower back. The discomfort associated with prolapse often is described as a pulling or aching sensation. It can be worse during sexual intercourse or menstruation.
• Heaviness or pressure in the vaginal area. Some women feel like something is about to fall out of the vagina.
• A bulge of moist pink tissue from the vagina. This exposed tissue may be irritated and cause itching or small sores that can bleed.
• Leakage of urine, which can be worse with heavy lifting, coughing, laughing or sneezing
• Frequent urination or a frequent urge to urinate
• Frequent urinary tract infections, because the bladder can’t empty completely when you urinate
• A need to push your fingers into your vagina, into your rectum, or against the skin near your vagina to empty your bladder or have a bowel movement
• Difficulty having a bowel movement
• Pain with sexual intercourse, urine leakage during sex, or an inability to have an orgasm
• Moist discharge that soils your undergarments

Diagnosis of Bladder Prolapse

A health care professional may ask about your

• symptoms, such as bulges or lumps in the vagina, pelvic pressure or heaviness, and urinary incontinence
• pregnancy and childbirth history
• current and past medical problems, including surgeries
• family history
• over-the-counter and prescription medicines
• bowel habits

History

It has a broad range of symptoms. Some patients may present as asymptomatic while others may demonstrate a significant impact on the quality of life, including the following symptoms[rx]:

• Pelvic pain/pressure
• Posterior vaginal bulge
• Obstructive defecation
• Incomplete defecation
• Constipation
• Dyspareunia
• Erosions and bleeding of mucosa if there is tissue exposure to the outside environment

Evaluation

• A pelvic exam – You may be examined while lying down and possibly while standing up. During the exam, your doctor looks for a tissue bulge in your vagina that indicates pelvic organ prolapse. You’ll likely be asked to bear down as if during a bowel movement to see how much that affects the degree of prolapse. To check the strength of your pelvic floor muscles, you’ll be asked to contact them, as if you’re trying to stop the stream of urine.
• Filling out a questionnaire – You may fill out a form that helps your doctor assess your medical history, the degree of your prolapse, and how much it affects your quality of life. This information also helps guide treatment decisions.
• Bladder and urine tests – If you have significant prolapse, you might be tested to see how well and completely your bladder empties. Your doctor might also run a test on a urine sample to look for signs of a bladder infection if it seems that you’re retaining more urine in your bladder than is normal after urinating.
• Urodynamics – Measures the bladder’s ability to hold and release urine.
• Cystoscopy (cystourethroscopy) – A long tube-like instrument is passed through the urethra to examine the bladder and urinary tract for malformations, blockages, tumors, or stone
• A special test – that can be done to confirm a rectocele is defecography. The patient will have a contrast medium instilled in the vagina, bladder, and rectum. Using a special commode, the patient will be instructed to defecate while the X-ray is taken. This test can be useful to determine the size of the rectocele, larger than 2 cm is considered abnormal.[rx]
• Urodynamic studies – can be helpful in patients with rectocele and complex voiding issues. If a patient is receiving surgery, it may be useful to determine if the patient has urinary incontinence with the prolapse reduced. If there is incontinence with reduction with prolapse, it may be helpful to include a procedure to prevent urinary incontinence in the plan.[rx]
• Pelvic floor strength test – During the pelvic examination, the doctor tests the strength of the pelvic floor, the sphincter muscles, and muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. Irregularities in this test can help diagnose vaginal prolapse and determine if kegel exercises would be helpful to the patient.
• Bladder function test – Otherwise known as urodynamics, bladder function tests determine the ability of the bladder to store and eliminate urine. This is measured in two ways. Uroflowmetry measures the volume and force of the urine stream. Cystometrogram is a procedure that fills the bladder with water via a catheter. Measurements of the volume are noted when the patient indicates the urgency of urination.

Another useful diagnostic tool for surgical planning is dynamic MRI (DMRI) which provides visualization of the rectocele and movements of the pelvic floor.[rx] DMRI is a valuable adjunct test when a patient’s symptoms are more significant than the physical examination findings suggest. Its use for preoperative planning has made it more widespread.[rx]

Treatments of Bladder Prolapse

Non-pharmacological

• Kegel exercises – Also known as pelvic floor exercises, Kegel exercises are simple and quick to do and can easily be slotted into your day. No one will even know you’re doing them! Kegel exercises are essential in preventing existing prolapses from deteriorating further.
• Maintain your weight – Excess weight is not only unhealthy for your heart, being overweight can put extra pressure on your pelvic floor muscles and cause, or worsen, a bladder prolapse. The National Institute for Heath and Care Excellence (NICE) recommends keeping your BMI under 30.
• Avoid constipation – Constant straining can weaken your pelvic floor muscles, cause hemorrhoids and anal bleeding. Eat well and stay hydrated so that your bowel movements are regular. A high fiber breakfast will help. You can also use a toilet stool to bring your knees up and force you into the ideal posture for fully eliminating your bowels when you’re on the toilet.
• Lift heavy weights safely – Lifting correctly will make all the difference to not only your back but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
• Have good posture, even when sitting down – Walk tall and sit tall; no slouching at your desk or in the car. Remember BBC – Bum to the Back of the Chair.
• Wearing a vaginal pessary – A vaginal pessary will help to better support even severely prolapsed bladders. It’s a small device, usually made from silicone, that is placed inside the vagina to help support the vaginal wall and keep the bladder in place. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women; your doctor can help you find the right one.
• Avoiding high impact exercise – High impact exercise puts increased pressure on the pelvic floor, especially troublesome if you suffer with stress incontinence. Stick to low impact, prolapse friendly workouts, such as swimming and road cycling.
• Using a pelvic toner – The Kegel8 Ultra 20 Pelvic Toner features a program specifically developed with prolapse in mind. Depending on the severity of your bladder prolapse, it can help reduce your symptoms and improve your bladder prolapse within 12 weeks by strengthening your pelvic floor muscles.

Your prolapsed bladder treatment very much depends on the severity of your condition. Many minor cases will not require treatment, and following the tips above can help prevent it from becoming a bladder prolapse that does.

• Non-surgical prolapsed bladder treatment – Kegel exercises using weighted vaginal cones to strengthen your pelvic muscles, and electronic pelvic toners with specific prolapsed bladder exercise programs, maybe all the treatment you need. Losing weight can also help significantly, as can wearing a vaginal pessary. In some menopausal women, estrogen replacement therapy can also help. These non-surgical treatments are often preferred, particularly when future children are desired, which may reduce the success of previous surgical procedures.
• Surgical prolapsed bladder treatment – There are circumstances when you might need surgical intervention for your prolapsed bladder; such as when non-surgical treatments do not fully relieve the symptoms and they remain severe. Procedures involve surgically repairing the vaginal wall and placing the bladder back into its natural position within the pelvic cavity. The most common surgical prolapsed bladder treatment is called an ‘anterior vaginal repair’. Your surgeon repairs the walls of the vagina by stitching the folded tissues onto themselves, to make them stronger. Some surgeries use synthetic or biological mesh as added support to weakened muscle. The use of synthetic mesh in these surgeries is currently only recommended within the context of research, as current evidence into the safety of the procedure is insufficient. Surgery is considered as an option only when symptoms are severe and cannot be treated through other means, as there is a risk of further damage in the case of complications. It is important to note that surgery is unable to repair the pelvic floor muscles, so you will need to perform pelvic floor exercises after your recovery to prevent the prolapse from returning and to support any synthetic or biological mesh from stretching which could lead to a prolapse reoccurring.

References

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Prolapse After Childbirth – What To Know, How To Do Prolapsed Uterine Bladder – Causes, Symptoms, Treatment Uterine Prolapse at a Young Age Uterine Prolapse – Causes, Symptoms, Treatment Protrusion of The Bladder – Causes, Symptoms, Treatment Vaginal Vault Prolapse – Causes, Symptoms, Treatment Prolapse Urethrocele – Causes, Symptoms, Treatment Enterocele Prolapse – Causes, Symptoms, Treatment Cystocele Prolapse – Causes, Symptoms, Treatment Rectal Prolapse – Causes, Symptoms, Diagnosis, Treatment Rectocele Prolapse – Causes, Symptoms, Treatment Vaginal Prolapse – Causes, Symptoms, Diagnosis, Treatment

Prolapsed Uterine Bladder causes the pressure inside the bladder to increase, causing discomfort and urinary incontinence. We’ve all experienced what it feels like to have a full bladder, with nowhere to empty it, and how it no longer sits comfortably within the pelvis. Urinary incontinence can range from occasional stress urinary incontinence, where women may leak a small amount of urine if they cough or sneeze, to a more severe inability to hold in urine.

The bladder is a balloon-shaped, muscular bag that sits comfortably within the pelvis as it constantly fills with urine. The muscular front walls of the vagina (anterior walls) and the pelvic area help to support the bladder and hold it in place. If the muscles in the front wall of the vagina loosen and deteriorate too much, then a bladder prolapse can occur, where the bladder falls into the vagina.

Bladder prolapse is a common condition in women. It can be disruptive, embarrassing, and inconvenient, but it is treatable.

bladder are held in their normal positions just above the inside end of the vagina by a “hammock” made up of supportive muscles and ligaments. Wear and tear on these supportive structures in the pelvis can allow the bottom of the uterus, the floor of the bladder or both to sag through the muscle and ligament layers.

When this occurs, the uterus or bladder can create a bulge into the vagina. In severe cases, it is possible for the sagging uterus or bladder to work its way down far enough that the bulge can appear at the vagina’s opening or even protrude from the opening.

When the uterus sags downward, it is called uterine prolapse. When the bladder sags, it is called bladder prolapse, also known as a cystocele.

Types of Prolapsed Uterine Bladder

Types of Bladder Prolapse Various stresses can cause the pelvic muscles and ligaments to weaken and lead to uterine or bladder prolapse. The most significant stress on these muscles and ligaments is childbirth. Women who have had multiple pregnancies and vaginal delivery are more likely to develop prolapse.

There are three different types of bladder prolapse, cystocele, urethrocele, and cystourethrocele. These can occur in isolation or together:

• Cystocele – The most common type of pelvic organ prolapse, when the whole bladder bulges or drops into the vagina. Cystocele is commonly associated with the prolapse of other organs within the pelvis.
• Urethrocele – When the tissues surrounding the urethra (the tube that carries urine from the bladder and out of the body) prolapse, or drop down into the vagina.
• Cystourethrocele – Both the bladder and the urethral tissues prolapse into the vagina together.

Stages of a Bladder Prolapse

Bladder prolapse is diagnosed by a doctor or surgeon, and can occur in three stages, or grades:

• Stage 1 – The bladder has dropped only a short distance into the vagina, and bladder prolapse symptoms are mild.
• Stage 2 – The bladder has dropped a further distance into the vagina and has reached the outer opening of the vagina. Bladder prolapse symptoms are moderate.
• Stage 3 – The bladder has dropped so sufficiently into the vagina, that it begins to protrude out through the outer opening of the vagina. Bladder prolapse symptoms become the most advanced they can get.

Causes of Prolapsed Uterine Bladder

The bladder and/or the urethral tissue can prolapse into the vagina if the pelvic floor muscles are weakened. These can be weakened by several factors:

• Pregnancy – Extra weight on the pelvic floor can cause the muscles to weaken.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse. Mothers who deliver four babies vaginally are at 12 times greater risk than women who have not given birth vaginally.
• Menopause – The change in hormones you experience during this time of your life, particularly the drop in estrogen, can cause your pelvic floor muscles to weaken. Effects can be worsened by the general loss of muscle tone associated with aging.
• Bodyweight – Being overweight or obese can increase your chances of suffering a pelvic organ prolapse due to the weight on your pelvic area.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smoker’s cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Heavy lifting – Repeated and incorrect heavy lifting puts extra pressure on your pelvic floor.
• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Hysterectomy – Many women who have had a hysterectomy (the complete removal of the womb and cervix) suffer a secondary prolapse. The uterus provides support for the other pelvic organs, if it is no longer there, then the bladder can gradually fall towards the vaginal opening.
• Previous pelvic surgeries – A hysterectomy or previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Medical conditions – Medical conditions that weaken the pelvic floor muscles, such as joint hypermobility syndrome (the ability to maneuver joints into unusual positions).

Symptoms of Prolapsed Uterine Bladder

There are many symptoms that accompany bladder prolapse. In the early stages of a prolapsed bladder, they may even be unnoticeable. The following warning signs are common and can be experienced as very mild to severe, you may also only experience a few of these symptoms:

• heaviness or a feeling of pressure in the vagina
• a feeling that there is something inside and/or falling out of the vagina
• visible tissue poking out from the vagina that is tender and/or bleeds
• a frequent urge and/or an urgent need to pass urine
• difficulty urinating, not feeling like your bladder has fully emptied after passing urine
• urinary incontinence – the inability to hold urine in when not on the toilet
• stress incontinence – passing small amounts of urine when coughing, sneezing, laughing, exercising or lifting heavyweight
• Nocturia – the medical term for getting up more than once during the night to pass urine
• discomfort and pain when urinating
• frequent bladder or urinary infections such as cystitis
• pain during sex
• pain in the lower back, pelvis or groin

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide which course of treatment is best for you.

or

Mild cases of bladder or uterine prolapse usually don’t cause any symptoms. A prolapse that is more advanced can cause any of the following symptoms:

• Discomfort in the vagina, pelvis, lower abdomen, groin or lower back. The discomfort associated with prolapse often is described as a pulling or aching sensation. It can be worse during sexual intercourse or menstruation.
• Heaviness or pressure in the vaginal area. Some women feel like something is about to fall out of the vagina.
• A bulge of moist pink tissue from the vagina. This exposed tissue may be irritated and cause itching or small sores that can bleed.
• Leakage of urine, which can be worse with heavy lifting, coughing, laughing or sneezing
• Frequent urination or a frequent urge to urinate
• Frequent urinary tract infections, because the bladder can’t empty completely when you urinate
• A need to push your fingers into your vagina, into your rectum, or against the skin near your vagina to empty your bladder or have a bowel movement
• Difficulty having a bowel movement
• Pain with sexual intercourse, urine leakage during sex, or an inability to have an orgasm
• Moist discharge that soils your undergarments

Diagnosis of Prolapsed Uterine Bladder

A health care professional may ask about your

• symptoms, such as bulges or lumps in the vagina, pelvic pressure or heaviness, and urinary incontinence
• pregnancy and childbirth history
• current and past medical problems, including surgeries
• family history
• over-the-counter and prescription medicines
• bowel habits

History

It has a broad range of symptoms. Some patients may present as asymptomatic while others may demonstrate a significant impact on the quality of life, including the following symptoms[rx]:

• Pelvic pain/pressure
• Posterior vaginal bulge
• Obstructive defecation
• Incomplete defecation
• Constipation
• Dyspareunia
• Erosions and bleeding of mucosa if there is tissue exposure to the outside environment

Evaluation

• A pelvic exam – You may be examined while lying down and possibly while standing up. During the exam, your doctor looks for a tissue bulge in your vagina that indicates pelvic organ prolapse. You’ll likely be asked to bear down as if during a bowel movement to see how much that affects the degree of prolapse. To check the strength of your pelvic floor muscles, you’ll be asked to contact them, as if you’re trying to stop the stream of urine.
• Filling out a questionnaire – You may fill out a form that helps your doctor assess your medical history, the degree of your prolapse, and how much it affects your quality of life. This information also helps guide treatment decisions.
• Bladder and urine tests – If you have significant prolapse, you might be tested to see how well and completely your bladder empties. Your doctor might also run a test on a urine sample to look for signs of a bladder infection if it seems that you’re retaining more urine in your bladder than is normal after urinating.
• Urodynamics – Measures the bladder’s ability to hold and release urine.
• Cystoscopy (cystourethroscopy) – A long tube-like instrument is passed through the urethra to examine the bladder and urinary tract for malformations, blockages, tumors, or stone
• A special test – that can be done to confirm a rectocele is defecography. The patient will have a contrast medium instilled in the vagina, bladder, and rectum. Using a special commode, the patient will be instructed to defecate while the X-ray is taken. This test can be useful to determine the size of the rectocele, larger than 2 cm is considered abnormal.[rx]
• Urodynamic studies – can be helpful in patients with rectocele and complex voiding issues. If a patient is receiving surgery, it may be useful to determine if the patient has urinary incontinence with the prolapse reduced. If there is incontinence with reduction with prolapse, it may be helpful to include a procedure to prevent urinary incontinence in the plan.[rx]
• Pelvic floor strength test – During the pelvic examination, the doctor tests the strength of the pelvic floor, the sphincter muscles, and muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. Irregularities in this test can help diagnose vaginal prolapse and determine if kegel exercises would be helpful to the patient.
• Bladder function test – Otherwise known as urodynamics, bladder function tests determine the ability of the bladder to store and eliminate urine. This is measured in two ways. Uroflowmetry measures the volume and force of the urine stream. Cystometrogram is a procedure that fills the bladder with water via a catheter. Measurements of the volume are noted when the patient indicates the urgency of urination.

Another useful diagnostic tool for surgical planning is dynamic MRI (DMRI) which provides visualization of the rectocele and movements of the pelvic floor.[rx] DMRI is a valuable adjunct test when a patient’s symptoms are more significant than the physical examination findings suggest. Its use for preoperative planning has made it more widespread.[rx]

Treatments of Prolapsed Uterine Bladder

Non-pharmacological

• Kegel exercises – Also known as pelvic floor exercises, Kegel exercises are simple and quick to do and can easily be slotted into your day. No one will even know you’re doing them! Kegel exercises are essential in preventing existing prolapses from deteriorating further.
• Maintain your weight – Excess weight is not only unhealthy for your heart, being overweight can put extra pressure on your pelvic floor muscles and cause, or worsen, a bladder prolapse. The National Institute for Heath and Care Excellence (NICE) recommends keeping your BMI under 30.
• Avoid constipation – Constant straining can weaken your pelvic floor muscles, cause hemorrhoids and anal bleeding. Eat well and stay hydrated so that your bowel movements are regular. A high fiber breakfast will help. You can also use a toilet stool to bring your knees up and force you into the ideal posture for fully eliminating your bowels when you’re on the toilet.
• Lift heavy weights safely – Lifting correctly will make all the difference to not only your back but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
• Have good posture, even when sitting down – Walk tall and sit tall; no slouching at your desk or in the car. Remember BBC – Bum to the Back of the Chair.
• Wearing a vaginal pessary – A vaginal pessary will help to better support even severely prolapsed bladders. It’s a small device, usually made from silicone, that is placed inside the vagina to help support the vaginal wall and keep the bladder in place. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women; your doctor can help you find the right one.
• Avoiding high impact exercise – High impact exercise puts increased pressure on the pelvic floor, especially troublesome if you suffer with stress incontinence. Stick to low impact, prolapse friendly workouts, such as swimming and road cycling.
• Using a pelvic toner – The Kegel8 Ultra 20 Pelvic Toner features a program specifically developed with prolapse in mind. Depending on the severity of your bladder prolapse, it can help reduce your symptoms and improve your bladder prolapse within 12 weeks by strengthening your pelvic floor muscles.

Your prolapsed bladder treatment very much depends on the severity of your condition. Many minor cases will not require treatment, and following the tips above can help prevent it from becoming a bladder prolapse that does.

• Non-surgical prolapsed bladder treatment – Kegel exercises using weighted vaginal cones to strengthen your pelvic muscles, and electronic pelvic toners with specific prolapsed bladder exercise programs, maybe all the treatment you need. Losing weight can also help significantly, as can wearing a vaginal pessary. In some menopausal women, estrogen replacement therapy can also help. These non-surgical treatments are often preferred, particularly when future children are desired, which may reduce the success of previous surgical procedures.
• Surgical prolapsed bladder treatment – There are circumstances when you might need surgical intervention for your prolapsed bladder; such as when non-surgical treatments do not fully relieve the symptoms and they remain severe. Procedures involve surgically repairing the vaginal wall and placing the bladder back into its natural position within the pelvic cavity. The most common surgical prolapsed bladder treatment is called an ‘anterior vaginal repair’. Your surgeon repairs the walls of the vagina by stitching the folded tissues onto themselves, to make them stronger. Some surgeries use synthetic or biological mesh as added support to weakened muscle. The use of synthetic mesh in these surgeries is currently only recommended within the context of research, as current evidence into the safety of the procedure is insufficient. Surgery is considered as an option only when symptoms are severe and cannot be treated through other means, as there is a risk of further damage in the case of complications. It is important to note that surgery is unable to repair the pelvic floor muscles, so you will need to perform pelvic floor exercises after your recovery to prevent the prolapse from returning and to support any synthetic or biological mesh from stretching which could lead to a prolapse reoccurring.

References

People Also Reading

Bladder Prolapse – Causes, Symptoms, Treatment Uterine Prolapse – Causes, Symptoms, Treatment Prolapsed Urethrocele – Causes, Symptoms, Treatment Prolapsed Enterocele – Causes, Symptoms, Treatment Uterine Prolapse at a Young Age Prolapsed Rectocele – Causes, Symptoms, Treatment Prolapsed Cystocele – Causes, Symptoms, Treatment Prolapsed Rectal – Causes, Symptoms, Treatment Protrusion of The Bladder – Causes, Symptoms, Treatment Prolapse After Childbirth – What To Know, How To Do Enterocele – Causes, Symptoms, Diagnosis, Treatment Uterine Cervix Inflammation – Causes, Symptoms, Treatment

A cystocele prolapse is when the bladder begins to droop down from its normal position, so much so that it protrudes into the front wall of the vagina, the anterior wall. Prolapse can happen to any organ of the pelvis; the bladder, small bowel, rectum, uterus or even the vagina itself. Any pelvic organ prolapse happens because the muscular system that holds everything in place, the pelvic floor muscles, have weakened.

A cystocele can be inconvenient and embarrassing, but it’s comforting to know that they are very common in women, even if they’re not talked about directly much. You may have heard mum’s talk about not being able to go on trampolines or chase their children around the park without leaking. Pregnancy, childbirth, and menopause can all contribute to a weakened pelvic floor but thankfully, performing daily pelvic floor exercises can help prevent, and treat, a cystocele prolapse.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to associated nerves – increasing the risk of it reoccurring. To avoid unnecessary delays and speak to your doctor if you have any concerns.

What Is the Difference Between a Cystocele and Rectocele Prolapse?

Any organ within the pelvic area can be affected by a weak pelvic floor, which can no longer hold them in place. A cystocele prolapse is a name for when the bladder bulges into the front (anterior) vaginal wall, and a rectocele prolapse is a name for when the rectum bulges into the back (posterior) wall of the vagina. It is common for both cystocele and rectocele prolapses to occur together, and luckily, they have many of the same treatments so can often be treated together.

Stages of Cystocele Prolapse

There are three main stages of a cystocele prolapse, your doctor will be able to diagnose which stage you are at:

• Stage 1 – The bladder has protruded only a short distance into the vaginal wall and symptoms are mild.
• Stage 2 – The bladder has protruded sufficiently into the vagina that it has reached the opening of the vagina. This protrusion may be visible from the outside of the vagina temporarily through coughing or straining.
• Stage 3 – The bladder has significantly protruded into the vagina and is permanently visibly bulging from the outside of the vagina.

Causes of Cystocele Prolapse

Being overweight or obese, having had multiple pregnancies, and going through menopause are all risk factors for developing a cystocele prolapse. As can anything that contributes to the weakening of the pelvic floor muscles:

• Pregnancy – Extra weight on the pelvic floor can cause the muscles to weaken.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse.
• Menopause – The change in hormones you experience during this time of your life, particularly the drop in estrogen, can cause your pelvic floor muscles to weaken. Effects can be worsened by the general loss of muscle tone associated with aging.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smoker’s cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Bodyweight – Being overweight or obese can increase your chances of suffering a prolapse due to the weight of your pelvic area.
• Heavy lifting – Repeated and incorrect heavy lifting puts extra pressure on your pelvic floor.
• Strenuous activity – Heavy, high impact exercises such as running or plyometric training (jump training) can cause the pelvic floor muscles to weaken.
• Previous pelvic surgeries – A previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Genetics – A family history of prolapse can suggest you are at a higher risk.
• Hysterectomy – The complete removal of the womb and cervix. The uterus provides support for the top of the vagina, if it is no longer there, then the top of the vagina can gradually fall towards the vaginal opening and the vaginal walls weaken.

Symptoms of  Cystocele Prolapse

If you believe you are developing a cystocele prolapse, or you have been diagnosed with one, then you may experience some or all of the following symptoms. The most common symptom being frequent bladder and urinary tract infections (cystitis):

• frequent bladder and urinary tract infections (cystitis)
• urinary stress incontinence – passing small streams or drops of urine when you cough, sneeze, laugh, jump, run or lift a heavy object or child
• urinary incontinence – the inability to hold in urine at all during everyday life
• a frequent urge to pass urine
• an urgent need to pass urine
• difficulty passing urine
• discomfort, pain or blood when passing urine
• not feeling satisfied that your bladder has emptied fully after going to the toilet
• pain in the lower back or pelvic area
• pain when having sex
• a feeling that there is something uncomfortable inside the vagina
• a feeling that there is something about to fall out of your vagina
• a feeling of heaviness, dragging or pressure inside the vagina
• unusual bleeding not associated with your period
• red tissue poking from the vagina when you cough or strain
• red tissue poking from your vagina permanently

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide on which course of treatment is best for you.

Diagnosis of Cystocele Prolapse

A health care professional may ask about your

• symptoms, such as bulges or lumps in the vagina, pelvic pressure or heaviness, and urinary incontinence
• pregnancy and childbirth history
• current and past medical problems, including surgeries
• family history
• over-the-counter and prescription medicines
• bowel habits

History

Rectoceles have a broad range of symptoms. Some patients may present as asymptomatic while others may demonstrate a significant impact on the quality of life, including the following symptoms[rx]:

• Pelvic pain/pressure
• Posterior vaginal bulge
• Obstructive defecation
• Incomplete defecation
• Constipation
• Dyspareunia
• Erosions and bleeding of mucosa if there is tissue exposure to the outside environment

Physical Exam

A thorough examination will include a vaginal exam, rectal exam, abdominal exam, and focused neurological exam.

The focused neurological exam consists of levator ani muscle tone and contraction strength.

The vaginal exam can be evaluated using the Baden-Walker or POP-Q exam. The Baden-Walker system utilizes one measurement. The distance of the most distal portion of the prolapse from the hymen while the patient is completing the Valsalva maneuver.[rx]

Treatments of Cystocele Prolapse

Sometimes, the only treatment you’ll need for a cystocele prolapse is regular pelvic floor exercises and some lifestyle changes. Usually, this will be the case if you have a mild cystocele or even a moderate one.

Surgery is considered as an option only when symptoms are severe and cannot be treated through other means, as there is a risk of further damage in the case of complications. Non-surgical treatments are also preferred when future children are desired, which can reduce the success of previous surgical procedures:

• Kegel exercises – Performing daily pelvic floor exercises could be all you need to keep your urethrocele prolapse under control. Using an electronic pelvic toner such as the Kegel8 Ultra 20 Pelvic Toner will make them more beneficial. Also known as pelvic floor exercises; you can do them quickly and easily, at any time of day as no one will know you’re doing them. They help to strengthen the pelvic floor muscles. You can make them even more effective by using an electronic pelvic toner.
• Maintain your weight – Making sure you stick to a healthy weight will put less pressure on your pelvic floor muscles, giving you more chance of keeping them strong. The National Institute for Heath and Care Excellence (NICE) recommends keeping your BMI under 30.
• Avoiding constipation – Eating a high fiber diet of fruits, vegetables, and wholegrain cereals will help your bowels stay regular, as will drinking plenty of water.
• Avoid straining on the toilet – Straining on the toilet puts unnecessary pressure on the pelvic floor muscles. Using a toilet stool when you pass a bowel movement will help avoid straining as it puts your body in the optimum position for fully emptying your bowels.
• Lift heavyweights (and children) safely – Lifting correctly will make all the difference to not only your back but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
• Avoid too much high impact exercise – High impact exercises are great for overall health. But if you’re worried about a prolapse, then gentler, lower impact exercise like swimming will be better.
• Treat that cough – Persistent heavy coughing can cause a weakening in the pelvic floor muscles that may not become apparent straight away. Get medical help for a cough that lasts longer than a week.
• Good posture – Make sure you have good posture, especially when seated – walk tall and sit tall with no slouching and adopt the BBC, Bum to the Back of the Chair, method.
• Lifestyle changes – Maintain a healthy weight and avoid constipation, heavy lifting and prolonged coughing.
• Hormone treatment – Hormone supplements and topical estrogen creams can help boost the levels of the hormones you may be lacking through menopause or age that weaken the pelvic floor.
• Wearing a vaginal pessary – A vaginal pessary will support a pelvic organ prolapse. It’s a small, usually silicone, device that is placed inside the vagina to help support the vaginal wall and prevent other pelvic organs from collapsing further into it. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women. Your doctor can help you find the right one and help you change the pessary every four to six months. This is commonly the favored treatment for those unable to undergo surgery due to medical conditions or those wishing to have children in the future.

In the circumstance of non-surgical treatments not fully relieving your symptoms and they remain severe, you may be advised to have a surgical intervention for your cystocele prolapse. However, as cystocele prolapse is a long term condition that requires long term treatment, you will be advised to undergo lifestyle changes and daily Kegel exercises to complement any successes following surgery.

Several surgical procedures are currently available and may be completed in conjunction to repair all prolapses you are experiencing:

• Surgery – Cystocele repair surgery involves lifting and moving the bladder and tightening the ligaments that hold it in place. Your surgeon will also strengthen the walls of your vagina with a few deep surgical stitches as a preventative measure. The three most common techniques are called anterior colporrhaphy, anterior colporrhaphy with graft and paravaginal repair. The use of synthetic mesh in these surgeries is currently only recommended within the context of research, as current evidence into the safety of the procedure is insufficient. It is important to note that surgery is unable to repair the pelvic floor muscles. You will need to perform pelvic floor exercises after your recovery to prevent the prolapse from returning and to support any synthetic or biological mesh from stretching which could lead to a prolapse recurrence.

How Long Does it Take to Recover from Cystocele Prolapse Surgery?

Following a cystocele repair surgery, a catheter and vaginal packing soaked with estrogen cream will be inserted and not removed until your appointment the following day. You would normally expect to be up and about as normal within four to six weeks. After six weeks, you should be able to have sex, but should refrain from heavy lifting or completing in any strenuous exercise for three months post-op. Further follow-up visits are usually 2 months after the operation, with a series of further follow-ups throughout the following year, and then eventually annually – at the discretion of the operating surgeon.

It is important to note that there are a number of reported complications associated with cystocele repair surgery. If a synthetic mesh has been used, there is a 25% risk of the material moving into the vagina causing pain. The use of synthetic mesh is also associated with three times more long-term complications than in patients without a synthetic mesh fitted. This includes feeling the mesh during sex, leading to painful sex for both parties, or in some cases the complete inability to have sex.

Following the recovery from a pelvic organ surgery, you may notice different or less sensation during sex. This can be improved by building pelvic floor / Kegel exercises, into your routine. A physiotherapist will be able to advise on the best pelvic floor exercises for you.

If you do opt for surgery, it is important to note that surgery cannot repair your pelvic floor muscles. You will need to perform pelvic floor exercises after your recovery, to prevent the prolapse from recurring. There is a 30% chance of developing a future prolapse following a pelvic organ surgery, due to the damage to the tissue. Other non-surgical treatments should also be followed to prevent future prolapses; such as eating well to avoid constipation and maintaining a healthy weight.

Complication

Post-surgical complications can develop. The complications following surgical treatment of cystocele are:

References

People Also Reading

Prolapse After Childbirth – What To Know, How To Do Apical Cystocele – Causes, Symptoms, Treatment Prolapsed Cystocele – Causes, Symptoms, Treatment Cystocele – Causes, Symptoms, Diagnosis, Treatment Medial Cystocele – Causes, Symptoms, Treatment Bladder Prolapse – Causes, Symptoms, Treatment Lateral Cystocele – Causes, Symptoms, Treatment Uterine Prolapse – Causes, Symptoms, Treatment Uterine Prolapse at a Young Age Prolapse Urethrocele – Causes, Symptoms, Treatment Vaginal Vault Prolapse – Causes, Symptoms, Treatment Enterocele Prolapse – Causes, Symptoms, Treatment

Prolapsed Cystocele is when the bladder begins to droop down from its normal position, so much so that it protrudes into the front wall of the vagina, the anterior wall. Prolapse can happen to any organ of the pelvis; the bladder, small bowel, rectum, uterus or even the vagina itself. Any pelvic organ prolapse happens because the muscular system that holds everything in place, the pelvic floor muscles, have weakened.

A cystocele can be inconvenient and embarrassing, but it’s comforting to know that they are very common in women, even if they’re not talked about directly much. You may have heard mum’s talk about not being able to go on trampolines or chase their children around the park without leaking. Pregnancy, childbirth, and menopause can all contribute to a weakened pelvic floor but thankfully, performing daily pelvic floor exercises can help prevent, and treat, a cystocele prolapse.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to associated nerves – increasing the risk of it reoccurring. To avoid unnecessary delays and speak to your doctor if you have any concerns.

What Is the Difference Between a Cystocele and Rectocele Prolapse?

Any organ within the pelvic area can be affected by a weak pelvic floor, which can no longer hold them in place. A cystocele prolapse is a name for when the bladder bulges into the front (anterior) vaginal wall, and a rectocele prolapse is a name for when the rectum bulges into the back (posterior) wall of the vagina. It is common for both cystocele and rectocele prolapses to occur together, and luckily, they have many of the same treatments so can often be treated together.

Stages of Cystocele Prolapse

There are three main stages of a cystocele prolapse, your doctor will be able to diagnose which stage you are at:

• Stage 1 – The bladder has protruded only a short distance into the vaginal wall and symptoms are mild.
• Stage 2 – The bladder has protruded sufficiently into the vagina that it has reached the opening of the vagina. This protrusion may be visible from the outside of the vagina temporarily through coughing or straining.
• Stage 3 – The bladder has significantly protruded into the vagina and is permanently visibly bulging from the outside of the vagina.

Causes of Prolapsed Cystocele

Being overweight or obese, having had multiple pregnancies, and going through menopause are all risk factors for developing a cystocele prolapse. As can anything that contributes to the weakening of the pelvic floor muscles:

• Pregnancy – Extra weight on the pelvic floor can cause the muscles to weaken.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse.
• Menopause – The change in hormones you experience during this time of your life, particularly the drop in estrogen, can cause your pelvic floor muscles to weaken. Effects can be worsened by the general loss of muscle tone associated with aging.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smoker’s cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Bodyweight – Being overweight or obese can increase your chances of suffering a prolapse due to the weight of your pelvic area.
• Heavy lifting – Repeated and incorrect heavy lifting puts extra pressure on your pelvic floor.
• Strenuous activity – Heavy, high impact exercises such as running or plyometric training (jump training) can cause the pelvic floor muscles to weaken.
• Previous pelvic surgeries – A previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Genetics – A family history of prolapse can suggest you are at a higher risk.
• Hysterectomy – The complete removal of the womb and cervix. The uterus provides support for the top of the vagina, if it is no longer there, then the top of the vagina can gradually fall towards the vaginal opening and the vaginal walls weaken.

Symptoms of  Prolapsed Cystocele

If you believe you are developing a cystocele prolapse, or you have been diagnosed with one, then you may experience some or all of the following symptoms. The most common symptom being frequent bladder and urinary tract infections (cystitis):

• frequent bladder and urinary tract infections (cystitis)
• urinary stress incontinence – passing small streams or drops of urine when you cough, sneeze, laugh, jump, run or lift a heavy object or child
• urinary incontinence – the inability to hold in urine at all during everyday life
• a frequent urge to pass urine
• an urgent need to pass urine
• difficulty passing urine
• discomfort, pain or blood when passing urine
• not feeling satisfied that your bladder has emptied fully after going to the toilet
• pain in the lower back or pelvic area
• pain when having sex
• a feeling that there is something uncomfortable inside the vagina
• a feeling that there is something about to fall out of your vagina
• a feeling of heaviness, dragging or pressure inside the vagina
• unusual bleeding not associated with your period
• red tissue poking from the vagina when you cough or strain
• red tissue poking from your vagina permanently

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide on which course of treatment is best for you.

Diagnosis of Prolapsed Cystocele

A health care professional may ask about your

• symptoms, such as bulges or lumps in the vagina, pelvic pressure or heaviness, and urinary incontinence
• pregnancy and childbirth history
• current and past medical problems, including surgeries
• family history
• over-the-counter and prescription medicines
• bowel habits

History

Rectoceles have a broad range of symptoms. Some patients may present as asymptomatic while others may demonstrate a significant impact on the quality of life, including the following symptoms[rx]:

• Pelvic pain/pressure
• Posterior vaginal bulge
• Obstructive defecation
• Incomplete defecation
• Constipation
• Dyspareunia
• Erosions and bleeding of mucosa if there is tissue exposure to the outside environment

Physical Exam

A thorough examination will include a vaginal exam, rectal exam, abdominal exam, and focused neurological exam.

The focused neurological exam consists of levator ani muscle tone and contraction strength.

The vaginal exam can be evaluated using the Baden-Walker or POP-Q exam. The Baden-Walker system utilizes one measurement. The distance of the most distal portion of the prolapse from the hymen while the patient is completing the Valsalva maneuver.[rx]

Treatments of Prolapsed Cystocele

Sometimes, the only treatment you’ll need for a cystocele prolapse is regular pelvic floor exercises and some lifestyle changes. Usually, this will be the case if you have a mild cystocele or even a moderate one.

Surgery is considered as an option only when symptoms are severe and cannot be treated through other means, as there is a risk of further damage in the case of complications. Non-surgical treatments are also preferred when future children are desired, which can reduce the success of previous surgical procedures:

• Kegel exercises – Performing daily pelvic floor exercises could be all you need to keep your urethrocele prolapse under control. Using an electronic pelvic toner such as the Kegel8 Ultra 20 Pelvic Toner will make them more beneficial. Also known as pelvic floor exercises; you can do them quickly and easily, at any time of day as no one will know you’re doing them. They help to strengthen the pelvic floor muscles. You can make them even more effective by using an electronic pelvic toner.
• Maintain your weight – Making sure you stick to a healthy weight will put less pressure on your pelvic floor muscles, giving you more chance of keeping them strong. The National Institute for Heath and Care Excellence (NICE) recommends keeping your BMI under 30.
• Avoiding constipation – Eating a high fiber diet of fruits, vegetables, and wholegrain cereals will help your bowels stay regular, as will drinking plenty of water.
• Avoid straining on the toilet – Straining on the toilet puts unnecessary pressure on the pelvic floor muscles. Using a toilet stool when you pass a bowel movement will help avoid straining as it puts your body in the optimum position for fully emptying your bowels.
• Lift heavyweights (and children) safely – Lifting correctly will make all the difference to not only your back but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
• Avoid too much high impact exercise – High impact exercises are great for overall health. But if you’re worried about a prolapse, then gentler, lower impact exercise like swimming will be better.
• Treat that cough – Persistent heavy coughing can cause a weakening in the pelvic floor muscles that may not become apparent straight away. Get medical help for a cough that lasts longer than a week.
• Good posture – Make sure you have good posture, especially when seated – walk tall and sit tall with no slouching and adopt the BBC, Bum to the Back of the Chair, method.
• Lifestyle changes – Maintain a healthy weight and avoid constipation, heavy lifting and prolonged coughing.
• Hormone treatment – Hormone supplements and topical estrogen creams can help boost the levels of the hormones you may be lacking through menopause or age that weaken the pelvic floor.
• Wearing a vaginal pessary – A vaginal pessary will support a pelvic organ prolapse. It’s a small, usually silicone, device that is placed inside the vagina to help support the vaginal wall and prevent other pelvic organs from collapsing further into it. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women. Your doctor can help you find the right one and help you change the pessary every four to six months. This is commonly the favored treatment for those unable to undergo surgery due to medical conditions or those wishing to have children in the future.

In the circumstance of non-surgical treatments not fully relieving your symptoms and they remain severe, you may be advised to have a surgical intervention for your cystocele prolapse. However, as cystocele prolapse is a long term condition that requires long term treatment, you will be advised to undergo lifestyle changes and daily Kegel exercises to complement any successes following surgery.

Several surgical procedures are currently available and may be completed in conjunction to repair all prolapses you are experiencing:

• Surgery – Cystocele repair surgery involves lifting and moving the bladder and tightening the ligaments that hold it in place. Your surgeon will also strengthen the walls of your vagina with a few deep surgical stitches as a preventative measure. The three most common techniques are called anterior colporrhaphy, anterior colporrhaphy with graft and paravaginal repair. The use of synthetic mesh in these surgeries is currently only recommended within the context of research, as current evidence into the safety of the procedure is insufficient. It is important to note that surgery is unable to repair the pelvic floor muscles. You will need to perform pelvic floor exercises after your recovery to prevent the prolapse from returning and to support any synthetic or biological mesh from stretching which could lead to a prolapse recurrence.

How Long Does it Take to Recover from Cystocele Prolapse Surgery?

Following a cystocele repair surgery, a catheter and vaginal packing soaked with estrogen cream will be inserted and not removed until your appointment the following day. You would normally expect to be up and about as normal within four to six weeks. After six weeks, you should be able to have sex, but should refrain from heavy lifting or completing in any strenuous exercise for three months post-op. Further follow-up visits are usually 2 months after the operation, with a series of further follow-ups throughout the following year, and then eventually annually – at the discretion of the operating surgeon.

It is important to note that there are a number of reported complications associated with cystocele repair surgery. If a synthetic mesh has been used, there is a 25% risk of the material moving into the vagina causing pain. The use of synthetic mesh is also associated with three times more long-term complications than in patients without a synthetic mesh fitted. This includes feeling the mesh during sex, leading to painful sex for both parties, or in some cases the complete inability to have sex.

Following the recovery from a pelvic organ surgery, you may notice different or less sensation during sex. This can be improved by building pelvic floor / Kegel exercises, into your routine. A physiotherapist will be able to advise on the best pelvic floor exercises for you.

If you do opt for surgery, it is important to note that surgery cannot repair your pelvic floor muscles. You will need to perform pelvic floor exercises after your recovery, to prevent the prolapse from recurring. There is a 30% chance of developing a future prolapse following a pelvic organ surgery, due to the damage to the tissue. Other non-surgical treatments should also be followed to prevent future prolapses; such as eating well to avoid constipation and maintaining a healthy weight.

Complication

Post-surgical complications can develop. The complications following surgical treatment of cystocele are:

References

People Also Reading

Prolapsed Uterine Bladder – Causes, Symptoms, Treatment Cystocele Prolapse – Causes, Symptoms, Treatment Prolapsed Urethrocele – Causes, Symptoms, Treatment Apical Cystocele – Causes, Symptoms, Treatment Cystocele – Causes, Symptoms, Diagnosis, Treatment Medial Cystocele – Causes, Symptoms, Treatment Lateral Cystocele – Causes, Symptoms, Treatment Prolapsed Rectocele – Causes, Symptoms, Treatment Prolapsed Enterocele – Causes, Symptoms, Treatment Prolapsed Rectal – Causes, Symptoms, Treatment Prolapse After Childbirth – What To Know, How To Do Enterocele – Causes, Symptoms, Diagnosis, Treatment

A Prolapse Urethrocele is of the female urethra into the vagina. The weakening of the tissues that hold the urethra in place may cause it to protrude into the vagina. Urethroceles often occur with cystoceles (involving the urinary bladder as well as the urethra). In this case, the term used is cystourethrocele.

The urethra is the tube that takes urine from the bladder to the outside of the body. It is part of the group of organs that make up the female pelvic area. These organs are held in place by strong pelvic floor muscles. As these muscles weaken, due to menopause, pregnancy, and aging (among other factors), each organ is at risk of prolapsing and dropping down into the pelvic cavity. If this happens to the urethra, it’s called a urethrocele prolapse. During a urethrocele, the urethra widens and begins to curve downwards and press into the vaginal wall. This usually results in further pelvic organ prolapses, causing a noticeable and often painful bulge.

A urethrocele prolapse can be disruptive, embarrassing, and inconvenient, but it is treatable.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to associated nerves – increasing the risk of recurrence. So avoid unnecessary delays and speak to your doctor if you have any concerns.

Stages of Urethrocele Prolapse

As with most female pelvic organ prolapses, a urethrocele prolapse can occur in varying degrees of severity:

• Stage 1 – The urethra begins to press down against the upper wall of the vagina and protrudes into it only to a slight degree. Symptoms can be mild or even unnoticeable.
• Stage 2 – The urethra has prolapsed, or dropped down, far enough into the vagina that it reaches the opening of the vagina but is not visible. Symptoms will be moderately uncomfortable or inconvenient.
• Stage 3 – The urethra has prolapsed down far enough that it protrudes outside of the vaginal opening. Symptoms will be severe, and the urethra will be visible from the outside of the body.

Symptoms of  Urethrocele Prolapse

In the early stages of a urethrocele prolapse you may have no symptoms at all and it, therefore, may only be diagnosed during a routine examination, such as a smear test. But it is also possible to experience any or all of the following symptoms severely:

• a feeling of pressure inside the vagina, especially when sitting down
• a dragging feeling inside the vagina, and/or feeling that something is going to fall out
• noticeable red tissue protruding from the vagina
• discomfort or pain during sex
• persistent or frequent urinary tract infections (cystitis)
• urinary stress incontinence – the inability to hold in urine when you cough, sneeze, laugh, exercise or lift heavy objects
• urinary incontinence – a complete inability to hold in urine
• a frequent need to urinate
• an urgent need to urinate
• difficulty passing urine and completely emptying your bladder

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide which course of treatment is best for you.

Some symptoms are similar to those experienced with a urinary tract infection (cystitis), which can often occur at the same time as a urethrocele prolapse.

Causes of Urethrocele Prolapse

Each one of these factors increases your risk of experiencing a urethrocele, or other type or pelvic organ prolapse, as they all result in weakened pelvic floor muscles:

• Pregnancy – This is in part due to the extra weight that the baby adds to the pelvic area, which can weaken the pelvic floor muscles. It is also thought to be caused by pregnancy hormones allowing vaginal tissues to stretch beyond their rebound limits. Multiple pregnancies will further increase your risk.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse.
• Menopause – The change in hormones you experience during this time of your life, particularly the drop in estrogen, can cause your pelvic floor muscles to weaken. Effects can be worsened by the general loss of muscle tone associated with aging.
• Hysterectomy – A hysterectomy is the complete removal of the uterus and cervix. This surgery removes some of the strength of the pelvic area as the uterus is no longer there as support.
• Bodyweight – Being overweight or obese can increase your chances of suffering a pelvic organ prolapse due to the weight on your pelvic area.
• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smoker’s cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Heavy lifting – Repetitive heavy lifting, and lifting incorrectly, increases the pressure put on the pelvic floor.
• Strenuous activity – Heavy, high impact exercises such as running or plyometric training (jump training) can cause the pelvic floor muscles to weaken.
• Previous pelvic surgeries – A previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Pelvic conditions – Heavy fibroids or a tumor somewhere in your pelvis can add weight to the area and weaken the pelvic floor muscles.

Diagnosis of Prolapse Urethrocele

Medical history

A health care professional may ask about your

• symptoms, such as bulges or lumps in the vagina, pelvic pressure or heaviness, and urinary incontinence
• pregnancy and childbirth history
• current and past medical problems, including surgeries
• family history
• over-the-counter and prescription medicines
• bowel habits

History

Rectoceles have a broad range of symptoms. Some patients may present as asymptomatic while others may demonstrate a significant impact on the quality of life, including the following symptoms[rx]:

• Pelvic pain/pressure
• Posterior vaginal bulge
• Obstructive defecation
• Incomplete defecation
• Constipation
• Dyspareunia
• Erosions and bleeding of mucosa if there is tissue exposure to the outside environment

Physical Exam

A thorough examination will include a vaginal exam, rectal exam, abdominal exam, and focused neurological exam.

The focused neurological exam consists of levator ani muscle tone and contraction strength.

The vaginal exam can be evaluated using the Baden-Walker or POP-Q exam. The Baden-Walker system utilizes one measurement. The distance of the most distal portion of the prolapse from the hymen while the patient is completing the Valsalva maneuver.[rx]

Evaluation

• A pelvic exam – You may be examined while lying down and possibly while standing up. During the exam, your doctor looks for a tissue bulge in your vagina that indicates pelvic organ prolapse. You’ll likely be asked to bear down as if during a bowel movement to see how much that affects the degree of prolapse. To check the strength of your pelvic floor muscles, you’ll be asked to contact them, as if you’re trying to stop the stream of urine.
• Filling out a questionnaire – You may fill out a form that helps your doctor assess your medical history, the degree of your prolapse, and how much it affects your quality of life. This information also helps guide treatment decisions.
• Bladder and urine tests – If you have significant prolapse, you might be tested to see how well and completely your bladder empties. Your doctor might also run a test on a urine sample to look for signs of a bladder infection if it seems that you’re retaining more urine in your bladder than is normal after urinating.
• Urodynamics – Measures the bladder’s ability to hold and release urine.
• Cystoscopy (cystourethroscopy) – A long tube-like instrument is passed through the urethra to examine the bladder and urinary tract for malformations, blockages, tumors, or stone
• A special test – that can be done to confirm a rectocele is defecography. The patient will have a contrast medium instilled in the vagina, bladder, and rectum. Using a special commode, the patient will be instructed to defecate while the X-ray is taken. This test can be useful to determine the size of the rectocele, larger than 2 cm is considered abnormal.[rx]
• Urodynamic studies – can be helpful in patients with rectocele and complex voiding issues. If a patient is receiving surgery, it may be useful to determine if the patient has urinary incontinence with the prolapse reduced. If there is incontinence with reduction with prolapse, it may be helpful to include a procedure to prevent urinary incontinence in the plan.[rx]
• Pelvic floor strength test – During the pelvic examination, the doctor tests the strength of the pelvic floor, the sphincter muscles, and muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. Irregularities in this test can help diagnose vaginal prolapse and determine if kegel exercises would be helpful to the patient.
• Bladder function test – Otherwise known as urodynamics, bladder function tests determine the ability of the bladder to store and eliminate urine. This is measured in two ways. Uroflowmetry measures the volume and force of the urine stream. Cystometrogram is a procedure that fills the bladder with water via a catheter. Measurements of the volume are noted when the patient indicates the urgency of urination.

Another useful diagnostic tool for surgical planning is dynamic MRI (DMRI) which provides visualization of the rectocele and movements of the pelvic floor.[rx] DMRI is a valuable adjunct test when a patient’s symptoms are more significant than the physical examination findings suggest. Its use for preoperative planning has made it more widespread.[rx]

Treatments for Urethrocele Prolapse

If you’ve suffered a urethrocele prolapse, speak to your doctor about what treatments may work for you. There are numerous different urethrocele prolapse treatments that work and depend on your personal circumstances. Targeted pelvic floor muscle exercises are a popular choice for seeing a quick and effective improvement in mild to moderate prolapses.

Surgery is considered as an option only when symptoms are severe and cannot be treated through other means, as there is a risk of further damage in the case of complications. Non-surgical treatments are also preferred when future children are desired, which can reduce the success of previous surgical procedures:

• Kegel exercises – Performing daily pelvic floor exercises could be all you need to keep your urethrocele prolapse under control. Using an electronic pelvic toner such as the Kegel8 Ultra 20 Pelvic Toner will make them more beneficial.
• Lifestyle changes – Maintain a healthy weight and avoid constipation, heavy lifting and prolonged coughing.
• Wearing a vaginal pessary – A vaginal pessary will support even severe pelvic organ prolapses. It’s a small, usually silicone, device that is placed inside the vagina to help support the vaginal wall and prevent other pelvic organs from collapsing further into it. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women. Your doctor can help you find the right one and help you change the pessary every four to six months. This is commonly the favored treatment for those unable to undergo surgery due to medical conditions or those wishing to have children in the future.
• Maintain your weight – Making sure you stick to a healthy weight will put less pressure on your pelvic floor muscles, giving you more chance of keeping them strong. The National Institute for Heath and Care Excellence (NICE) recommends keeping your BMI under 30.
• Avoiding constipation – Eating a high fiber diet of fruits, vegetables, and wholegrain cereals will help your bowels stay regular, as will drinking plenty of water.
• Lift heavyweights (and children) safely – Lifting correctly will make all the difference to not only your back, but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
• Avoid too much high impact exercise – High impact exercises are great for overall health. But if you’re worried about a prolapse, then gentler, lower impact exercise like swimming will be better.
• Treat that cough – Persistent heavy coughing can cause a weakening in the pelvic floor muscles that may not become apparent straight away. Get medical help for a cough that lasts longer than a week.
• Good posture – Make sure you have good posture, especially when seated – walk tall and sit tall with no slouching and adopt the BBC, Bum to the Back of the Chair, method.
• Estrogen cream – Oestrogen cream should be applied 2-3 times a day for a course of two weeks, directly to the prolapsed urethra. This treatment is not recommended if bleeding is occurring. In postmenopausal women, you may be prescribed a long term course of treatment following a urethrocele surgery.
• Antibiotics – The use of topical antibiotics is prescribed for complex situations and those where the infection is present. This treatment is not recommended if bleeding is occurring.
• Sitz bath – These hot saltwater baths can be purchased relativity cheaply. Used once or twice a day, they can reduce the discomfort for mild urethrocele prolapses.

In the circumstance of non-surgical treatments not fully relieving your symptoms and they remain severe, you may be advised to have a surgical intervention for your urethrocele prolapse. The surgery may be completed in conjunction with others, to repair all prolapses you are experiencing at once:

• Surgery – Surgery is usually the last resort and is used for women with severe urethral prolapses. The aim of the surgery is to remove tissue that is no longer functional and restore strength in the urethra. During surgery, usually through the vagina, but sometimes through the abdomen, your surgeon will lift the urethra back into place and remove part of the mucosa (mucous membrane) that covers the urethra. They will usually also add a few deep dissolvable surgical stitches to the vaginal wall to help strengthen it. It is important to note that surgery is unable to repair the pelvic floor muscles. You will need to perform pelvic floor exercises after your recovery to prevent the prolapse from returning.

How Long Does It Take to Recover from a Urethrocele Prolapse Surgery?

Most urethrocele surgeries are completed under general anesthetic and you will be able to leave the hospital the same day, with a catheter fitted. In the following two or three days, you will attend a post-operative appointment to remove the catheter, and can normally expect to be back to your usual self within four to six weeks.

Your doctor will book an appointment with you four or five weeks after the surgery. At this appointment, you may be prescribed antibiotics to treat any associated urinary tract infections. In some cases, the repair of a pelvic organ prolapse can uncover other related underlying conditions such as damage to the bladder or bowel. Your doctor will discuss whether these require further treatment following your recovery.

Following the recovery from a pelvic organ surgery, you may notice different or fewer sensations during sex. This can be improved by building pelvic floor / Kegel exercises, into your routine. A physiotherapist will be able to advise on the best pelvic floor exercises for you. There is also a small risk of urinary incontinence following surgery if the urethra was shortened.

What Is the Difference Between a Urethrocele and a Cystocele Prolapse?

A urethrocele is a prolapse of the urethra only. If the pelvic floor muscles weaken and allow the bladder to prolapse, then this is separately called a cystocele. Often, both a urethrocele and a cystocele occur at the same time and the prolapse is then called a cystourethrocele.

References

People Also Reading

Prolapse After Childbirth – What To Know, How To Do Prolapsed Urethrocele – Causes, Symptoms, Treatment Urethrocele – Causes, Symptoms, Treatment Bladder Prolapse – Causes, Symptoms, Treatment Uterine Prolapse – Causes, Symptoms, Treatment Vaginal Vault Prolapse – Causes, Symptoms, Treatment Uterine Prolapse at a Young Age Enterocele Prolapse – Causes, Symptoms, Treatment Cystocele Prolapse – Causes, Symptoms, Treatment Vaginal Prolapse – Causes, Symptoms, Diagnosis, Treatment Rectal Prolapse – Causes, Symptoms, Diagnosis, Treatment Rectocele Prolapse – Causes, Symptoms, Treatment

A Prolapsed Urethrocele is of the female urethra into the vagina. The weakening of the tissues that hold the urethra in place may cause it to protrude into the vagina. Urethroceles often occur with cystoceles (involving the urinary bladder as well as the urethra). In this case, the term used is cystourethrocele.

The urethra is the tube that takes urine from the bladder to the outside of the body. It is part of the group of organs that make up the female pelvic area. These organs are held in place by strong pelvic floor muscles. As these muscles weaken, due to menopause, pregnancy, and aging (among other factors), each organ is at risk of prolapsing and dropping down into the pelvic cavity. If this happens to the urethra, it’s called a urethrocele prolapse. During a urethrocele, the urethra widens and begins to curve downwards and press into the vaginal wall. This usually results in further pelvic organ prolapses, causing a noticeable and often painful bulge.

A urethrocele prolapse can be disruptive, embarrassing, and inconvenient, but it is treatable.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to associated nerves – increasing the risk of recurrence. So avoid unnecessary delays and speak to your doctor if you have any concerns.

Stages of Prolapsed Urethrocele

As with most female pelvic organ prolapses, a urethrocele prolapse can occur in varying degrees of severity:

• Stage 1 – The urethra begins to press down against the upper wall of the vagina and protrudes into it only to a slight degree. Symptoms can be mild or even unnoticeable.
• Stage 2 – The urethra has prolapsed, or dropped down, far enough into the vagina that it reaches the opening of the vagina but is not visible. Symptoms will be moderately uncomfortable or inconvenient.
• Stage 3 – The urethra has prolapsed down far enough that it protrudes outside of the vaginal opening. Symptoms will be severe, and the urethra will be visible from the outside of the body.

Causes of Prolapsed Urethrocele

Each one of these factors increases your risk of experiencing a urethrocele, or other type or pelvic organ prolapse, as they all result in weakened pelvic floor muscles:

• Pregnancy – This is in part due to the extra weight that the baby adds to the pelvic area, which can weaken the pelvic floor muscles. It is also thought to be caused by pregnancy hormones allowing vaginal tissues to stretch beyond their rebound limits. Multiple pregnancies will further increase your risk.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse.
• Menopause – The change in hormones you experience during this time of your life, particularly the drop in estrogen, can cause your pelvic floor muscles to weaken. Effects can be worsened by the general loss of muscle tone associated with aging.
• Hysterectomy – A hysterectomy is the complete removal of the uterus and cervix. This surgery removes some of the strength of the pelvic area as the uterus is no longer there as support.
• Bodyweight – Being overweight or obese can increase your chances of suffering a pelvic organ prolapse due to the weight on your pelvic area.
• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smoker’s cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Heavy lifting – Repetitive heavy lifting, and lifting incorrectly, increases the pressure put on the pelvic floor.
• Strenuous activity – Heavy, high impact exercises such as running or plyometric training (jump training) can cause the pelvic floor muscles to weaken.
• Previous pelvic surgeries – A previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Pelvic conditions – Heavy fibroids or a tumor somewhere in your pelvis can add weight to the area and weaken the pelvic floor muscles.

Symptoms of  Prolapsed Urethrocele

In the early stages of a urethrocele prolapse you may have no symptoms at all and it, therefore, may only be diagnosed during a routine examination, such as a smear test. But it is also possible to experience any or all of the following symptoms severely:

• a feeling of pressure inside the vagina, especially when sitting down
• a dragging feeling inside the vagina, and/or feeling that something is going to fall out
• noticeable red tissue protruding from the vagina
• discomfort or pain during sex
• persistent or frequent urinary tract infections (cystitis)
• urinary stress incontinence – the inability to hold in urine when you cough, sneeze, laugh, exercise or lift heavy objects
• urinary incontinence – a complete inability to hold in urine
• a frequent need to urinate
• an urgent need to urinate
• difficulty passing urine and completely emptying your bladder

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide which course of treatment is best for you.

Some symptoms are similar to those experienced with a urinary tract infection (cystitis), which can often occur at the same time as a urethrocele prolapse.

Diagnosis of Prolapsed Urethrocele

Medical history

A health care professional may ask about your

• symptoms, such as bulges or lumps in the vagina, pelvic pressure or heaviness, and urinary incontinence
• pregnancy and childbirth history
• current and past medical problems, including surgeries
• family history
• over-the-counter and prescription medicines
• bowel habits

History

Rectoceles have a broad range of symptoms. Some patients may present as asymptomatic while others may demonstrate a significant impact on the quality of life, including the following symptoms[rx]:

• Pelvic pain/pressure
• Posterior vaginal bulge
• Obstructive defecation
• Incomplete defecation
• Constipation
• Dyspareunia
• Erosions and bleeding of mucosa if there is tissue exposure to the outside environment

Physical Exam

A thorough examination will include a vaginal exam, rectal exam, abdominal exam, and focused neurological exam.

The focused neurological exam consists of levator ani muscle tone and contraction strength.

The vaginal exam can be evaluated using the Baden-Walker or POP-Q exam. The Baden-Walker system utilizes one measurement. The distance of the most distal portion of the prolapse from the hymen while the patient is completing the Valsalva maneuver.[rx]

Evaluation

• A pelvic exam – You may be examined while lying down and possibly while standing up. During the exam, your doctor looks for a tissue bulge in your vagina that indicates pelvic organ prolapse. You’ll likely be asked to bear down as if during a bowel movement to see how much that affects the degree of prolapse. To check the strength of your pelvic floor muscles, you’ll be asked to contact them, as if you’re trying to stop the stream of urine.
• Filling out a questionnaire – You may fill out a form that helps your doctor assess your medical history, the degree of your prolapse, and how much it affects your quality of life. This information also helps guide treatment decisions.
• Bladder and urine tests – If you have significant prolapse, you might be tested to see how well and completely your bladder empties. Your doctor might also run a test on a urine sample to look for signs of a bladder infection if it seems that you’re retaining more urine in your bladder than is normal after urinating.
• Urodynamics – Measures the bladder’s ability to hold and release urine.
• Cystoscopy (cystourethroscopy) – A long tube-like instrument is passed through the urethra to examine the bladder and urinary tract for malformations, blockages, tumors, or stone
• A special test – that can be done to confirm a rectocele is defecography. The patient will have a contrast medium instilled in the vagina, bladder, and rectum. Using a special commode, the patient will be instructed to defecate while the X-ray is taken. This test can be useful to determine the size of the rectocele, larger than 2 cm is considered abnormal.[rx]
• Urodynamic studies – can be helpful in patients with rectocele and complex voiding issues. If a patient is receiving surgery, it may be useful to determine if the patient has urinary incontinence with the prolapse reduced. If there is incontinence with reduction with prolapse, it may be helpful to include a procedure to prevent urinary incontinence in the plan.[rx]
• Pelvic floor strength test – During the pelvic examination, the doctor tests the strength of the pelvic floor, the sphincter muscles, and muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. Irregularities in this test can help diagnose vaginal prolapse and determine if kegel exercises would be helpful to the patient.
• Bladder function test – Otherwise known as urodynamics, bladder function tests determine the ability of the bladder to store and eliminate urine. This is measured in two ways. Uroflowmetry measures the volume and force of the urine stream. Cystometrogram is a procedure that fills the bladder with water via a catheter. Measurements of the volume are noted when the patient indicates the urgency of urination.

Another useful diagnostic tool for surgical planning is dynamic MRI (DMRI) which provides visualization of the rectocele and movements of the pelvic floor.[rx] DMRI is a valuable adjunct test when a patient’s symptoms are more significant than the physical examination findings suggest. Its use for preoperative planning has made it more widespread.[rx]

Treatments for Prolapsed Urethrocele

If you’ve suffered a urethrocele prolapse, speak to your doctor about what treatments may work for you. There are numerous different urethrocele prolapse treatments that work and depend on your personal circumstances. Targeted pelvic floor muscle exercises are a popular choice for seeing a quick and effective improvement in mild to moderate prolapses.

Surgery is considered as an option only when symptoms are severe and cannot be treated through other means, as there is a risk of further damage in the case of complications. Non-surgical treatments are also preferred when future children are desired, which can reduce the success of previous surgical procedures:

• Kegel exercises – Performing daily pelvic floor exercises could be all you need to keep your urethrocele prolapse under control. Using an electronic pelvic toner such as the Kegel8 Ultra 20 Pelvic Toner will make them more beneficial.
• Lifestyle changes – Maintain a healthy weight and avoid constipation, heavy lifting and prolonged coughing.
• Wearing a vaginal pessary – A vaginal pessary will support even severe pelvic organ prolapses. It’s a small, usually silicone, device that is placed inside the vagina to help support the vaginal wall and prevent other pelvic organs from collapsing further into it. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women. Your doctor can help you find the right one and help you change the pessary every four to six months. This is commonly the favored treatment for those unable to undergo surgery due to medical conditions or those wishing to have children in the future.
• Maintain your weight – Making sure you stick to a healthy weight will put less pressure on your pelvic floor muscles, giving you more chance of keeping them strong. The National Institute for Heath and Care Excellence (NICE) recommends keeping your BMI under 30.
• Avoiding constipation – Eating a high fiber diet of fruits, vegetables, and wholegrain cereals will help your bowels stay regular, as will drinking plenty of water.
• Lift heavyweights (and children) safely – Lifting correctly will make all the difference to not only your back, but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
• Avoid too much high impact exercise – High impact exercises are great for overall health. But if you’re worried about a prolapse, then gentler, lower impact exercise like swimming will be better.
• Treat that cough – Persistent heavy coughing can cause a weakening in the pelvic floor muscles that may not become apparent straight away. Get medical help for a cough that lasts longer than a week.
• Good posture – Make sure you have good posture, especially when seated – walk tall and sit tall with no slouching and adopt the BBC, Bum to the Back of the Chair, method.
• Estrogen cream – Oestrogen cream should be applied 2-3 times a day for a course of two weeks, directly to the prolapsed urethra. This treatment is not recommended if bleeding is occurring. In postmenopausal women, you may be prescribed a long term course of treatment following a urethrocele surgery.
• Antibiotics – The use of topical antibiotics is prescribed for complex situations and those where the infection is present. This treatment is not recommended if bleeding is occurring.
• Sitz bath – These hot saltwater baths can be purchased relativity cheaply. Used once or twice a day, they can reduce the discomfort for mild urethrocele prolapses.

In the circumstance of non-surgical treatments not fully relieving your symptoms and they remain severe, you may be advised to have a surgical intervention for your urethrocele prolapse. The surgery may be completed in conjunction with others, to repair all prolapses you are experiencing at once:

• Surgery – Surgery is usually the last resort and is used for women with severe urethral prolapses. The aim of the surgery is to remove tissue that is no longer functional and restore strength in the urethra. During surgery, usually through the vagina, but sometimes through the abdomen, your surgeon will lift the urethra back into place and remove part of the mucosa (mucous membrane) that covers the urethra. They will usually also add a few deep dissolvable surgical stitches to the vaginal wall to help strengthen it. It is important to note that surgery is unable to repair the pelvic floor muscles. You will need to perform pelvic floor exercises after your recovery to prevent the prolapse from returning.

How Long Does It Take to Recover from a Urethrocele Prolapse Surgery?

Most urethrocele surgeries are completed under general anesthetic and you will be able to leave the hospital the same day, with a catheter fitted. In the following two or three days, you will attend a post-operative appointment to remove the catheter, and can normally expect to be back to your usual self within four to six weeks.

Your doctor will book an appointment with you four or five weeks after the surgery. At this appointment, you may be prescribed antibiotics to treat any associated urinary tract infections. In some cases, the repair of a pelvic organ prolapse can uncover other related underlying conditions such as damage to the bladder or bowel. Your doctor will discuss whether these require further treatment following your recovery.

Following the recovery from a pelvic organ surgery, you may notice different or fewer sensations during sex. This can be improved by building pelvic floor / Kegel exercises, into your routine. A physiotherapist will be able to advise on the best pelvic floor exercises for you. There is also a small risk of urinary incontinence following surgery if the urethra was shortened.

What Is the Difference Between a Urethrocele and a Cystocele Prolapse?

A urethrocele is a prolapse of the urethra only. If the pelvic floor muscles weaken and allow the bladder to prolapse, then this is separately called a cystocele. Often, both a urethrocele and a cystocele occur at the same time and the prolapse is then called a cystourethrocele.

References

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Rectal prolapse occurs when the connective tissues within the rectal passage loosen and stretch until they protrude through the anus. As the rectum becomes more prolapsed, ligaments and muscles may weaken until the rectum completely and permanently protrudes out of the body through the anus. This stage is called a complete prolapse, or a full-thickness rectal prolapse. Initially, the rectum may protrude and retract depending on your movements and activities. If the condition remains untreated it may protrude permanently.

The rectum is the final part of the digestive system, which sits just before the anus. It’s the area that holds faeces before you pass a bowel movement. It is made up of rectal wall lining (the mucosa), a layer of strong muscle, and some fatty tissue.

Although rectal prolapses are most common in older women (six times more likely to occur in women over 50 years old than in men of the same age), rectal prolapse can occur in men and women of all ages. In men, rectal prolapses are more common in those under 40 years old.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to your anal sphincter and associated nerves – increasing the risk of it reoccurring. So avoid unnecessary delays and speak to your doctor if you have any concerns.

Stages of  Rectal Prolapse

There are various stages of rectal prolapse, which generally affect different ages:

• Full-thickness (complete) rectal prolapse – When part or all of the rectum falls out of place and protrudes from the anus. This is the most common type of rectal prolapse for all ages.
• Internal rectal prolapse (intussusception) – Occurs when the rectum has weakened sufficiently to fold in on itself as sections higher up fall down. This happens inside your body and your rectum will not poke out of your anus. An internal rectal prolapse is most common in children. In adults, this grade of prolapse is usually related to other intestinal problems such as tumour growths.
• Partial (mucosal) rectal prolapse – It is possible to also have a partial (mucosal) rectal prolapse, where only the mucosal lining of the rectum protrudes from the anus. A partial (mucosal) rectal prolapse is most common in children under 2 years old.

In the most severe cases of rectal prolapse, the large intestine may also fall from its natural position and, with the rectum, fall down. The stretching of tissue and straightening of the intestine, resulting in severe faecal incontinence. If your rectal prolapse protrudes from your anus when passing stool, in the early stages you may be able to push it back up into your anus or simply standing up may cause it to retract. Eventually, however, gently pushing it back up may only work temporarily or you may not be able to get it to retract at all. Therefore it is important to get your condition diagnosed early and seek treatment.

Causes of Rectal Prolapse

Any of the following may cause a rectal prolapse:

• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse.
• Previous pelvic surgeries – A hysterectomy or previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Bodyweight – Being overweight or obese can increase your chances of suffering a rectal prolapse due to the weight on your pelvic area.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smokers cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Strenuous activity – Heavy, high impact exercises such as running or plyometric training (jump training) can cause the pelvic floor muscles to weaken.
• Chronic diarrhoea – Parasitic infections that result in chronic diarrhoea such as amoebiasis or schistosomiasis.
• Neurological conditions – Certain neurological conditions such as multiple sclerosis, spinal tumours or lumbar disc disease that put pressure on the nerves of the lower back, bowel and rectum.
• Certain medications – Certain medications increase the likelihood of developing a rectal prolapse, always read the information leaflet that accompanies your medication.
• Genetics and physical development problems – Certain genetics increase the likelihood of developing a rectal prolapse, including autism and others associated with a developmental delay.
• Cystic fibrosis – Children who develop a rectal prolapse should be tested for cystic fibrosis when the cause of the prolapse is not obvious.

Symptoms of  Rectal Prolapse

If you have a rectal prolapse, you may experience some or all of the following symptoms:

• faecal incontinence or stools uncontrollably leaking from the anus
• leaking mucus or blood from the anus
• a constant feeling of a full bowel
• an urgent need to have a bowel movement
• constipation
• passing many small stools
• a feeling of not having fully emptied the bowel
• a feeling of sitting on a ball
• inability to control gas/flatus incontinence
• anal irritation including pain, itching and bleeding
• red tissue that extends out of the anus that may or may not retract when you stand up
• red tissue that extends out of the anus when coughing, sneezing or heavy lifting

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide which course of treatment is best for you.

Diagnosis of Rectal Prolapse

Medical history

A health care professional may ask about your

• symptoms, such as bulges or lumps in the vagina, pelvic pressure or heaviness, and urinary incontinence
• pregnancy and childbirth history
• current and past medical problems, including surgeries
• family history
• over-the-counter and prescription medicines
• bowel habits

History

Rectoceles have a broad range of symptoms. Some patients may present as asymptomatic while others may demonstrate a significant impact on the quality of life, including the following symptoms[rx]:

• Pelvic pain/pressure
• Posterior vaginal bulge
• Obstructive defecation
• Incomplete defecation
• Constipation
• Dyspareunia
• Erosions and bleeding of mucosa if there is tissue exposure to the outside environment

Physical Exam

A thorough examination will include a vaginal exam, rectal exam, abdominal exam, and focused neurological exam.

The focused neurological exam consists of levator ani muscle tone and contraction strength.

The vaginal exam can be evaluated using the Baden-Walker or POP-Q exam. The Baden-Walker system utilizes one measurement. The distance of the most distal portion of the prolapse from the hymen while the patient is completing the Valsalva manoeuvre.[rx]

Treatments for Rectal Prolapse

Depending on how severe your rectal prolapse is, there are a number of treatment options to treat the accompanying symptoms. It is wise to consider all non-surgical treatments before discussing surgery with your doctor. Targeted pelvic floor muscle exercises are a popular choice for seeing a quick and effective improvement in your prolapse. Non-surgical treatments will reduce your symptoms and lead to a faster recovery if you are advised to undergo surgery.

• Avoid constipation – Eating a healthy diet, rich in fibre, and ensuring you drink plenty of water will help to keep your bowels regular. High fibre foods include fruit, vegetables and wholegrain cereals. Regular, gentle exercise will also help to keep things moving as they should.
• Avoid straining – Straining on the toilet when trying to empty your bowels will put unnecessary pressure on your pelvic floor area. Causing the pelvic floor muscles to weaken and eventually allow a rectal prolapse. Going to the toilet using a toilet stool will bring your knees up and force you into the ideal posture for fully eliminating your bowels. For children, using a potty-training toilet can offer this support.
• Keep to a healthy weight – The National Institute for Heath and Care Excellence (NICE) recommend keeping your BMI under 30.
• Kegel exercises – Regularly performing Kegel / pelvic floor exercises will help to strengthen the pelvic floor muscles. The stronger these muscles, the more the organs in the whole pelvic region are likely to stay in place and avoid moving downwards and prolapsing.
• Treat chronic diarrhoea – If you have a persistent stomach bug and/or you’re constantly passing loose stools, seek medical help to resolve the problem.
• Lifestyle treatments – Change your diet to include more fibre, stay hydrated and avoid constipation and straining. Dietary changes can be enough to reverse a minor partial (mucosal) rectal prolapse, when in conjunction with pelvic floor exercises.
• Stool softeners – Stool softeners may be prescribed to treat constipation.
• Prescribed bulking laxatives – Your doctor may suggest a bulking laxative, such as Fybogel. This group of laxatives help you pass a bowel movement without needing to strain.
• Pelvic floor strengthening exercises and toners – A tried and true method is getting into the habit of performing regular pelvic floor strengthening exercises. These can make a real difference in reducing the symptoms of a rectal prolapse and can be made even more effective through the use of pelvic floor toners such as the Kegel8 Ultra 20 Electronic Pelvic Toner.
• Pushing your prolapsed rectum back up – Your doctor may teach you how to safely and gently push your prolapsed rectum back up inside your anus. To do this, it’s a good idea to add a water-based lubricant to your finger, to allow a smoother passage and cause less discomfort.
• Surgery – Your doctor will only look into surgical options following a physical examination and where they are satisfied by your medical history. If there is any uncertainty, it is likely that you will be recommended to try non-surgical treatments before proceeding down the path of surgery. If surgery is determined to be a suitable solution, your surgery will follow a colonoscopy and will aim to restore the positioning of the rectum to correct functionality as a secondary outcome. There are two ways in which a surgeon can repair a prolapsed rectum; either through the anus (also known as perineal), or through the abdomen. Your surgeon will decide which method is best for you, based on your age, gender, other medical complications and the severity of your rectal prolapse. Depending on the type of surgery you have, you will either have a general anaesthetic, a local anaesthetic with muscle relaxing medications, or a spinal block to numb the area, which is similar to an epidural given during childbirth. If x-rays show that lifelong constipation will continue to be an issue, your surgeon may also remove a portion of your colon at the same time as the rectal prolapse repair to further improve bowel function. If you do opt for surgery, it is important to note that surgery cannot repair your pelvic floor muscles. You will need to perform pelvic floor exercises after you recover from your surgery, to prevent the rectal prolapse from recurring and to support any synthetic or biological mesh from stretching.

How Long Does It Take to Recover from Rectal Prolapse Surgery?

A hospital stay following surgery to correct a rectal prolapse can be anywhere from six days to two weeks. Perineal surgery (through your anus), generally leads to a shorter hospital stay than any abdominal surgery. With recovery being the fastest for keyhole surgery (laparoscopic) to the abdomen over open abdominal surgery.

It is important to note that surgery is unable to repair your pelvic floor muscles, so you will need to perform pelvic floor exercises after your recovery to prevent the rectal prolapse from reoccurring. Other non-surgical treatments should also be followed to prevent future prolapses; such as eating well to avoid constipation and using a toilet stool to reduce straining.

References

People Also Reading

Rectal Prolapse – Causes, Symptoms, Diagnosis, Treatment Prolapsed Rectal – Causes, Symptoms, Treatment What Is Rectal Prolapse? – Causes, Symptoms, Treatment Prolapse After Childbirth – What To Know, How To Do Vaginal Prolapse – Causes, Symptoms, Diagnosis, Treatment Enterocele Prolapse – Causes, Symptoms, Treatment Rectocele Prolapse – Causes, Symptoms, Treatment Enterocele – Causes, Symptoms, Diagnosis, Treatment Prolapse Urethrocele – Causes, Symptoms, Treatment Uterine Prolapse – Causes, Symptoms, Treatment Bladder Prolapse – Causes, Symptoms, Treatment Cystocele Prolapse – Causes, Symptoms, Treatment

Prolapsed Rectal occurs when the connective tissues within the rectal passage loosen and stretch until they protrude through the anus. As the rectum becomes more prolapsed, ligaments and muscles may weaken until the rectum completely and permanently protrudes out of the body through the anus. This stage is called a complete prolapse, or a full-thickness rectal prolapse. Initially, the rectum may protrude and retract depending on your movements and activities. If the condition remains untreated it may protrude permanently.

The rectum is the final part of the digestive system, which sits just before the anus. It’s the area that holds faeces before you pass a bowel movement. It is made up of rectal wall lining (the mucosa), a layer of strong muscle, and some fatty tissue.

Although rectal prolapses are most common in older women (six times more likely to occur in women over 50 years old than in men of the same age), rectal prolapse can occur in men and women of all ages. In men, rectal prolapses are more common in those under 40 years old.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to your anal sphincter and associated nerves – increasing the risk of it reoccurring. So avoid unnecessary delays and speak to your doctor if you have any concerns.

Stages of  Prolapsed Rectal

There are various stages of rectal prolapse, which generally affect different ages:

• Full-thickness (complete) rectal prolapse – When part or all of the rectum falls out of place and protrudes from the anus. This is the most common type of rectal prolapse for all ages.
• Internal rectal prolapse (intussusception) – Occurs when the rectum has weakened sufficiently to fold in on itself as sections higher up fall down. This happens inside your body and your rectum will not poke out of your anus. An internal rectal prolapse is most common in children. In adults, this grade of prolapse is usually related to other intestinal problems such as tumor growths.
• Partial (mucosal) rectal prolapse – It is possible to also have a partial (mucosal) rectal prolapse, where only the mucosal lining of the rectum protrudes from the anus. A partial (mucosal) rectal prolapse is most common in children under 2 years old.

In the most severe cases of rectal prolapse, the large intestine may also fall from its natural position and, with the rectum, fall down. The stretching of tissue and straightening of the intestine, resulting in severe faecal incontinence. If your rectal prolapse protrudes from your anus when passing stool, in the early stages you may be able to push it back up into your anus or simply standing up may cause it to retract. Eventually, however, gently pushing it back up may only work temporarily or you may not be able to get it to retract at all. Therefore it is important to get your condition diagnosed early and seek treatment.

Causes of Prolapsed Rectal

Any of the following may cause a rectal prolapse:

• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse.
• Previous pelvic surgeries – A hysterectomy or previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Bodyweight – Being overweight or obese can increase your chances of suffering a rectal prolapse due to the weight on your pelvic area.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smokers cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Strenuous activity – Heavy, high impact exercises such as running or plyometric training (jump training) can cause the pelvic floor muscles to weaken.
• Chronic diarrhoea – Parasitic infections that result in chronic diarrhoea such as amoebiasis or schistosomiasis.
• Neurological conditions – Certain neurological conditions such as multiple sclerosis, spinal tumors or lumbar disc disease that put pressure on the nerves of the lower back, bowel, and rectum.
• Certain medications – Certain medications increase the likelihood of developing a rectal prolapse, always read the information leaflet that accompanies your medication.
• Genetics and physical development problems – Certain genetics increase the likelihood of developing a rectal prolapse, including autism and others associated with a developmental delay.
• Cystic fibrosis – Children who develop a rectal prolapse should be tested for cystic fibrosis when the cause of the prolapse is not obvious.

Symptoms of  Prolapsed Rectal

If you have a rectal prolapse, you may experience some or all of the following symptoms:

• fecal incontinence or stools uncontrollably leaking from the anus
• leaking mucus or blood from the anus
• a constant feeling of a full bowel
• an urgent need to have a bowel movement
• constipation
• passing many small stools
• a feeling of not having fully emptied the bowel
• a feeling of sitting on a ball
• inability to control gas/flatus incontinence
• anal irritation including pain, itching and bleeding
• red tissue that extends out of the anus that may or may not retract when you stand up
• red tissue that extends out of the anus when coughing, sneezing or heavy lifting

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide which course of treatment is best for you.

Diagnosis of Prolapsed Rectal

Medical history

A health care professional may ask about your

• symptoms, such as bulges or lumps in the vagina, pelvic pressure or heaviness, and urinary incontinence
• pregnancy and childbirth history
• current and past medical problems, including surgeries
• family history
• over-the-counter and prescription medicines
• bowel habits

History

Rectoceles have a broad range of symptoms. Some patients may present as asymptomatic while others may demonstrate a significant impact on the quality of life, including the following symptoms[rx]:

• Pelvic pain/pressure
• Posterior vaginal bulge
• Obstructive defecation
• Incomplete defecation
• Constipation
• Dyspareunia
• Erosions and bleeding of mucosa if there is tissue exposure to the outside environment

Physical Exam

A thorough examination will include a vaginal exam, rectal exam, abdominal exam, and focused neurological exam.

The focused neurological exam consists of levator ani muscle tone and contraction strength.

The vaginal exam can be evaluated using the Baden-Walker or POP-Q exam. The Baden-Walker system utilizes one measurement. The distance of the most distal portion of the prolapse from the hymen while the patient is completing the Valsalva manoeuvre.[rx]

Treatments of Prolapsed Rectal

Depending on how severe your rectal prolapse is, there are a number of treatment options to treat the accompanying symptoms. It is wise to consider all non-surgical treatments before discussing surgery with your doctor. Targeted pelvic floor muscle exercises are a popular choice for seeing a quick and effective improvement in your prolapse. Non-surgical treatments will reduce your symptoms and lead to a faster recovery if you are advised to undergo surgery.

• Avoid constipation – Eating a healthy diet, rich in fiber, and ensuring you drink plenty of water will help to keep your bowels regular. High fiber foods include fruit, vegetables, and wholegrain cereals. Regular, gentle exercise will also help to keep things moving as they should.
• Avoid straining – Straining on the toilet when trying to empty your bowels will put unnecessary pressure on your pelvic floor area. Causing the pelvic floor muscles to weaken and eventually allow a rectal prolapse. Going to the toilet using a toilet stool will bring your knees up and force you into the ideal posture for fully eliminating your bowels. For children, using a potty-training toilet can offer this support.
• Keep to a healthy weight – The National Institute for Health and Care Excellence (NICE) recommend keeping your BMI under 30.
• Kegel exercises – Regularly performing Kegel / pelvic floor exercises will help to strengthen the pelvic floor muscles. The stronger these muscles, the more the organs in the whole pelvic region are likely to stay in place and avoid moving downwards and prolapsing.
• Treat chronic diarrhea – If you have a persistent stomach bug and/or you’re constantly passing loose stools, seek medical help to resolve the problem.
• Lifestyle treatments – Change your diet to include more fiber, stay hydrated, and avoid constipation and straining. Dietary changes can be enough to reverse a minor partial (mucosal) rectal prolapse, when in conjunction with pelvic floor exercises.
• Stool softeners – Stool softeners may be prescribed to treat constipation.
• Prescribed bulking laxatives – Your doctor may suggest a bulking laxative, such as Fybogel. This group of laxatives helps you pass a bowel movement without needing to strain.
• Pelvic floor strengthening exercises and toners – A tried and true method is getting into the habit of performing regular pelvic floor strengthening exercises. These can make a real difference in reducing the symptoms of rectal prolapse and can be made even more effective through the use of pelvic floor toners such as the Kegel8 Ultra 20 Electronic Pelvic Toner.
• Pushing your prolapsed rectum back up – Your doctor may teach you how to safely and gently push your prolapsed rectum back up inside your anus. To do this, it’s a good idea to add a water-based lubricant to your finger, to allow a smoother passage and cause less discomfort.
• Surgery – Your doctor will only look into surgical options following a physical examination and where they are satisfied by your medical history. If there is any uncertainty, it is likely that you will be recommended to try non-surgical treatments before proceeding down the path of surgery. If surgery is determined to be a suitable solution, your surgery will follow a colonoscopy and will aim to restore the positioning of the rectum to correct functionality as a secondary outcome. There are two ways in which a surgeon can repair a prolapsed rectum; either through the anus (also known as perineal) or through the abdomen. Your surgeon will decide which method is best for you, based on your age, gender, other medical complications, and the severity of your rectal prolapse. Depending on the type of surgery you have, you will either have a general anesthetic, a local anesthetic with muscle relaxing medications, or a spinal block to numb the area, which is similar to an epidural given during childbirth. If x-rays show that lifelong constipation will continue to be an issue, your surgeon may also remove a portion of your colon at the same time as the rectal prolapse repair to further improve bowel function. If you do opt for surgery, it is important to note that surgery cannot repair your pelvic floor muscles. You will need to perform pelvic floor exercises after you recover from your surgery, to prevent the rectal prolapse from recurring and to support any synthetic or biological mesh from stretching.

How Long Does It Take to Recover from Rectal Prolapse Surgery?

A hospital stay following surgery to correct a rectal prolapse can be anywhere from six days to two weeks. Perineal surgery (through your anus), generally leads to a shorter hospital stay than any abdominal surgery. With recovery being the fastest for keyhole surgery (laparoscopic) to the abdomen over open abdominal surgery.

It is important to note that surgery is unable to repair your pelvic floor muscles, so you will need to perform pelvic floor exercises after your recovery to prevent the rectal prolapse from reoccurring. Other non-surgical treatments should also be followed to prevent future prolapses; such as eating well to avoid constipation and using a toilet stool to reduce straining.

References

People Also Reading

Rectal Prolapse – Causes, Symptoms, Diagnosis, Treatment Prolapsed Rectocele – Causes, Symptoms, Treatment Prolapsed Enterocele – Causes, Symptoms, Treatment Prolapsed Urethrocele – Causes, Symptoms, Treatment Prolapsed Uterine Bladder – Causes, Symptoms, Treatment Prolapsed Cystocele – Causes, Symptoms, Treatment What Is Rectal Prolapse? – Causes, Symptoms, Treatment Rectal Prolapse – Causes, Symptoms, Diagnosis, Treatment Pouch of Douglas Descent – Symptoms, Treatment Sigmoidocele – Causes, Symptoms, Treatment Enterocele – Causes, Symptoms, Diagnosis, Treatment Rectal Cancer – Causes, Symptoms, Diagnosis, Treatment

A Prolapsed Rectocele is a type of prolapse where the supportive wall of tissue between a woman’s rectum and vaginal wall weakens. Without the support of these pelvic floor muscles and ligaments, the front wall of the rectum sags and bulges into the vagina, and in severe cases, protrudes out of the vaginal opening.

The rectum is at the very end of the digestive system, where feces collects before it is expelled from the body through the anus. It is normally separated from the vagina by a wall of thick, strong muscle. A rectocele prolapse is a type of pelvic organ prolapse, occurring on the back posterior wall of the vagina, where the rectal wall pushes against the vaginal wall, creating a bulge that can eventually tear into the vagina.

Rectocele prolapses are most common in women aged over 60 years old that have had multiple children. This is in part due to the menopause contributing to the weakening of the pelvic floor muscles as the levels of the hormone estrogen fall, and the extra weight pregnancy puts on the pelvic floor muscles causing long-lasting damage.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to associated nerves – increasing the risk of it reoccurring. To avoid unnecessary delays and speak to your doctor if you have any concerns.

Stages of Prolapsed Rectocele

A rectocele doesn’t always become severe, it may always remain a mild problem. However, it is important to acknowledge when symptoms progress and treat them accordingly:

• Mild rectocele prolapse – A mild rectocele is when you may not notice that you have a rectocele developing as there are no associated symptoms presenting themselves. You may only be diagnosed following a routine examination or procedure such as a smear test.
• Moderate rectocele prolapse – If your rectocele becomes worse, then you may begin to experience some or all of the symptoms listed above. You may also notice that your rectocele becomes more pronounced if you strain during a bowel movement, or cough violently. During these times, you may notice or feel red tissue protruding from the vagina that retracts back when you’ve finished straining or coughing.
• Severe rectocele prolapse – Eventually, your rectocele may become severe and you’ll be experiencing symptoms that get worse throughout the day. In this case, your rectum may be protruding permanently through your vagina.

Causes of Prolapsed Rectocele

As with all pelvic organ prolapses in women, one of the major causes of a rectocele prolapse is pregnancy and childbirth. Particularly if you carried a large baby and had a difficult birth with sustained pushing, enhanced further with multiple births. However, if damage to the pelvic floor muscles occurs during this time, you are unlikely to experience prolapse problems straight away.

The following factors can also lead to a rectocele prolapse as they all add extra pressure to the pelvic floor muscles, potentially weakening them:

• Pregnancy – Around 50% of women who have carried a baby to full term will experience some kind of vaginal prolapse. This is in part due to the extra weight that the baby adds to the pelvic area, which can weaken the pelvic floor muscles. It is also thought to be caused by pregnancy hormones allowing vaginal tissues to stretch beyond their rebound limits. Multiple pregnancies will increase your risk.
• Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse. Mothers who have delivered four babies vaginally are at 12 times greater risk than women who have not given birth vaginally.
• Menopause – The change in hormones you experience during this time of your life, particularly the drop in oestrogen, can cause your pelvic floor muscles to weaken. Effects can be worsened by the loss of muscle tone associated with aging.
• Bodyweight – Being overweight or obese can increase your chances of suffering a pelvic organ prolapse due to the weight on your pelvic area.
• Genetics – If someone else in your family has suffered a vaginal prolapse, then you may be at an increased risk.
• Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor and could cause it to weaken.
• Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smoker’s cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
• Heavy lifting – Repetitive heavy lifting, and lifting incorrectly, increases the pressure put on the pelvic floor.
• Strenuous activity – Heavy, high impact exercises such as running or plyometric training (jump training) can cause the pelvic floor muscles to weaken.
• Previous pelvic surgeries – A hysterectomy or previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
• Pelvic conditions – Heavy fibroids or a tumor somewhere in your pelvis can add weight to the area and weaken the pelvic floor muscles.
• Hysterectomy – Up to 40% of women who have had a hysterectomy (the complete removal of the womb and cervix) suffer a vaginal vault prolapse. The uterus provides support for the top of the vagina, if it is no longer there, then the top of the vagina can gradually fall towards the vaginal opening and the vaginal walls weaken, allowing other organs to protrude.

Symptoms of Prolapsed Rectocele

A rectocele prolapse is not always accompanied by any obvious symptoms, as the pelvic floor muscles may have weakened over many years. Generally, if the rectum bulges into the vagina to a depth of less than 2cm (1 inch), you may not experience any discomfort. In fact, 40% of women with a rectocele prolapse are only diagnosed by a routine examination or procedure such as a smear test.

Some of the common symptoms that you may experience for a rectocele prolapse include:

• a protrusion or bulge into the vagina that you can feel through everyday movements
• a feeling that something is inside the vagina
• pain or discomfort during sex
• constipation
• pain in the rectum
• unusual bleeding that isn’t associated with your period
• a feeling of pressure in the rectum
• difficulty passing a bowel movement, as the effects of the bulge become more noticeable
• a feeling that the bowel hasn’t completely emptied after a bowel movement
• finding it hard to hold in a stool or wind
• lower back or pelvic pain that is relieved by lying down
• lower back or pelvic pain that gets progressively worse during the day or whilst standing and is at its worst in the evening

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important and can help you decide which course of treatment is best for you.

Similar symptoms can also be experienced with Irritable Bowel Syndrome (IBS) and as such, a rectocele prolapse can often be misdiagnosed as IBS.

Diagnosis of Prolapsed Rectocele

Medical history

A health care professional may ask about your

• symptoms, such as bulges or lumps in the vagina, pelvic pressure or heaviness, and urinary incontinence
• pregnancy and childbirth history
• current and past medical problems, including surgeries
• family history
• over-the-counter and prescription medicines
• bowel habits

History

Rectoceles have a broad range of symptoms. Some patients may present as asymptomatic while others may demonstrate a significant impact on the quality of life, including the following symptoms[rx]:

• Pelvic pain/pressure
• Posterior vaginal bulge
• Obstructive defecation
• Incomplete defecation
• Constipation
• Dyspareunia
• Erosions and bleeding of mucosa if there is tissue exposure to the outside environment

Physical Exam

A thorough examination will include a vaginal exam, rectal exam, abdominal exam, and focused neurological exam.

The focused neurological exam consists of levator ani muscle tone and contraction strength.

The vaginal exam can be evaluated using the Baden-Walker or POP-Q exam. The Baden-Walker system utilizes one measurement. The distance of the most distal portion of the prolapse from the hymen while the patient is completing the Valsalva maneuver.[rx]

Treatments of Prolapsed Rectocele

If you’ve suffered a rectocele prolapse, speak to your doctor about which of the numerous treatments may work best for you. Targeted pelvic floor muscle exercises are a popular choice for seeing a quick and effective improvement in your prolapse.

Surgery is considered as an option only when symptoms are severe and cannot be treated through other means, as success rates are comparatively low and there is a risk of further damage in the case of complications. Effective non-surgical treatments are also preferred when future children are desired, which can reduce the success of previous surgical procedures in the pelvic area:

• Kegel exercises – These are also known as pelvic floor exercises. You can do them quickly and easily, at any time of day as no one will know you’re doing them. They help to strengthen the pelvic floor muscles. You can make them even more effective by using a Kegel8 Ultra 20 Pelvic Toner.
• Maintain your weight – Making sure you stick to a healthy weight will put less pressure on your pelvic floor muscles, giving you more chance of keeping them strong. The National Institute for Health and Care Excellence (NICE) recommends keeping your BMI under 30.
• Avoiding constipation – Eating a high fiber diet of fruits, vegetables, and wholegrain cereals will help your bowels stay regular, as will drinking plenty of water.
• Avoid straining on the toilet – Straining on the toilet puts unnecessary pressure on the pelvic floor muscles. Using a toilet stool when you pass a bowel movement will help avoid straining as it puts your body in the optimum position for fully emptying your bowels.
• Lift heavyweights (and children) safely – Lifting correctly will make all the difference to not only your back but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
• Avoid too much high impact exercise – High impact exercises are great for overall health. But if you’re worried about uterine prolapse, then gentler, lower impact exercise may be better for you.
• Treat that cough – Persistent heavy coughing can cause a weakening in the pelvic floor muscles that may not become apparent straight away. Get medical help for a cough that lasts longer than a week or so.
• Pelvic floor exercises – Regular pelvic floor exercises really can make all the difference and may well be all the treatment you need to keep your rectocele symptoms at bay. Like any muscle, the more you train the pelvic floor, the stronger it will become. Kegels need to be carried out every day and can be made more worthwhile by using the Kegel8 Ultra 20 Electronic Pelvic Toner. Used in conjunction with a biofeedback tool, you can understand how to make the most of pelvic floor exercises.
• Lifestyle changes – Managing your weight, quitting smoking, lifting correctly, and performing low impact exercise can also help. As can doing all you can to avoid constipation, even if that means occasional laxative use. Eating a high fiber diet of 25+ grams a day and drinking in excess of 6 glasses of water are shown to help reduce constipation.
• Hormone replacement therapy (HRT) – HRT can help women manage the symptoms of menopause, plus the extra oestrogen will help keep the pelvic floor muscles strong.
• Wearing a vaginal pessary – A vaginal pessary is a small device, usually made from silicone, that is placed inside the vagina to help support the vaginal wall and prevent other pelvic organs from collapsing further into it. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women. Your doctor can help you find the right one and help you change the pessary as required, usually every four to six months. This is commonly the favored treatment for those with a severe rectocele prolapse who are unable to undergo surgery due to other medical conditions, or those wishing to have children in the future.
• Surgery – In the circumstance that your rectocele prolapse remains a significant barrier to continuing with your daily routine, regardless of your incorporation of non-surgical treatments into your lifestyle, you may be advised to have surgical intervention. Surgery is a last resort reserved for severe rectoceles. It involves repositioning the rectum back into place and adding stitches to the wall of the vagina to encourage scarring as added strength. The surgery can be performed through the abdomen (open or through keyhole/laparoscopically), vagina, anus, or perineum (the space between your vagina and anus). These can be categorized as transvaginal, transanal, and transperineal repairs. These surgeries reconstruct the vagina and rectal walls, sometimes using synthetic or biological mesh as added support to weakened muscle. The use of synthetic mesh in these surgeries is currently only recommended within the context of research, as current evidence into the safety of the procedure is insufficient. The success of the surgery depends on many factors; including your overall health, the length of time that the prolapse had existed, and your symptoms. There are a number of risks associated with undergoing surgery for a rectocele prolapse; including blood clots in the legs or lungs, infection, and injury to nearby organs. Following the surgery, up to 50% of patients report sexual dysfunction and pain, a feeling of incomplete bowel emptying, and fecal incontinence, and in some patients, these symptoms worsened. There is also a reported 30% chance of developing a future prolapse following pelvic surgery, due to the damage to the vaginal tissue. Overall, following a rectocele repair surgery, improvement is felt in 75-90% of patients initially, falling to 50-60% after two years.

How Long Does it Take to Recover from Rectocele Prolapse Surgery?

You may be required to stay in the hospital for one or two nights following surgery on your rectocele prolapse. During this time you will be encouraged to walk to avoid blood clots and be prescribed pain medication to reduce the cramps, bloating, and lower backache. Recovery time after a rectocele repair surgery can be from three to eight weeks depending on your overall health. During which time you can expect a bright red or pink-colored vaginal discharge for the first six weeks, turning to a brownish or yellow towards the end. It is important to not have sex during this time as it suggests the wound is still healing. It is also important to complete the only light activity, urinate frequently (to avoid discomfort), eat well (to avoid constipation), and not rush to return to work and your daily activities.

Although you may have recovered from the surgery in three to eight weeks, a rectocele is what’s known as a long-term condition. It won’t heal or get better on its own. Kegel / pelvic floor exercises, along with the recommended lifestyle changes, will need to be continued for life in order to keep the pelvic floor muscles strong and prolapses from getting worse or recurring.

If you do opt for surgery, it is important to note that surgery cannot repair your pelvic floor muscles. You will need to perform pelvic floor exercises after you recover from your surgery, to prevent the prolapse from recurring and to support any synthetic or biological mesh from stretching.

What Is the Difference Between a Rectocele Prolapse, a Rectal Prolapse, and a Cystocele Prolapse?

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. See below for how rectocele prolapses differ from rectal and cystocele prolapses.

Rectal Prolapse

Whereas during a rectocele the rectum protrudes into the vagina, rectal prolapse is where the walls of the rectum protrude down through the anus. A rectal prolapse of any severity can occur in men and children, as well as in women. In both types of prolapse, when severe the rectum can end up dropping down so far that it protrudes outside of the body; either through the vagina (severe rectocele), or the anus (severe rectal prolapse).

Cystocele Prolapse

Just like a rectocele is a prolapse of the rectum into the vagina, a cystocele is a prolapse of the bladder into the vagina. A cystocele is known as an anterior wall prolapse as the prolapse bulges into the vagina through its front wall. The cause of both prolapses are the same – a weakness in the pelvic floor muscles that correspond to each organ. Therefore if you have a rectocele you are more prone to developing a cystocele. You must strengthen your pelvic floor with Kegel / pelvic floor exercises to reduce your risk.

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