What is Vaginal Prolapse? Is It even Real? Don`t Panic!

Introduction

Very recently, Jennifer Garner described her OB doctor telling her that her vagina might collapse. Now, what exactly does that mean? Today we’re going to talk all about vaginal collapse or pelvic organ prolapse or Vaginal Prolapse. So, you might be wondering, like, what can collapse, what does that even mean? And what is vaginal collapse? We’ll mine collapse. What causes it? How do you figure this out, and what can you do about it?

What is Vaginal Collapse?

Well, it’s not exactly collapsing, but it can prolapse. So, the way to think about pelvic organ prolapse is the vagina is in a U-shape. The top part is the anterior vaginal wall. Behind that, typically the bladder sits. The apex of the vagina is usually where the uterus or small bowel sits, and at the posterior part of the vagina is where the rectum sits.

So, you may hear terms like cystocele or rectocele, my bladder is falling out, but really it’s all the vagina that is coming down and out of the vagina. Now, this doesn’t happen to everybody, but it does happen in about 40 percent of women. However, not everyone is bothered by prolapse, and what does that mean? Not everyone gets symptoms that cause them to feel worried about it.

So, you might have a little bit of prolapse, but it’s not causing any problems, and that’s okay. Only about 12 percent of people actually notice discomfort or problems from their prolapse. That’s still a large number of people, but it’s certainly not as scary as 40. The good news is that this is not life-threatening or dangerous. This is a quality of life issue the majority of the time.

What are the Symptom?

You may notice you have it because when you see something coming out down there, you might feel like something’s falling out, like a tampon. You may feel some pelvic pressure or pelvic pain, or even lower back pain. Sometimes you might notice some symptoms with urination, like you got to more frequently or urgently, or you’re having difficulty emptying your bladder. You also make those difficulties with your bowel movements, having constipation or leakage of stool. And lastly, you might notice some discomfort with sex.

What causes it?

What causes Vaginal prolapse? Well, age certainly contributes to it. So, as you age, your muscles of the pelvic floor get weaker, which can make pelvic organ prolapse more likely. Also, doing certain activities over a course of a lifetime, so if you’re standing for long periods of time during your life, if you’re doing a lot of high-intensity exercise, or you’ve had multiple vaginal deliveries or even multiple pregnancies, that’s always putting pressure on the pelvic floor, which can cause it to weaken.

Some people also with a chronic cough can cause weakness because they’re coughing all the time, which is increasing pressure on the pelvic floor muscles, causing weakness. And lastly, certain genetic conditions or connective tissue disorders can put you at higher risk as well.

What to do when you think you have Vaginal prolapse?

So, if you think you might have prolapse, what should you do about it? Well, first of all, you want to know, is this bothering you or not? If it’s not bothering you, you should still get checked out just to make sure that it is prolapse and nothing else. But rest assured that there’s probably nothing you have to do about it.

If it is bothering you, then absolutely see a doctor who specializes in Vaginal prolapse, either a female pelvic medicine reconstructive surgeon who’s trained in urology or a urogynecologist who’s trained in gynecology. During your visit, you can expect that you’ll talk about your symptoms, what’s bothering you. And it’s really important for you, even if your doctor doesn’t ask, to tell them what’s bothering you the most.

Are you just wanting to know that you’re okay, or are you worried about it and you want to have a treatment? Because then they can really tailor the discussion to what’s important to you. And they’ll also do a physical examination. Now, what this includes is usually you’ll use a speculum, but usually you’ll just use half the speculum just to look at the walls of the vagina.

We’re not doing a pap smear like you get at the gynecologist. During the examination, you’ll also get what’s called a digital exam, where the doctor will place a finger in the vagina to feel the muscles of the vagina, to assess for how weak they are and assess for any other abnormalities like cysts or things of that nature. They may also ask you to squeeze and do a Kegel exercise so they can assess how strong those muscles actually are.

After this is done, they may ask for other testing depending on what you decide to do. So if you decide to have surgery, they may do what’s called a urodynamic test. And what this test is, is a test to assess what the function of your bladder is. And they’ll do it normally, and then they’ll put what’s called a pessary or a silicone dish in the vagina to hold things up, to assess how lifting the prolapse up will affect bladder function, particularly to assess if you’re going to leak.

And this is because when you lift things up with prolapse, it can actually take away that buzz that was supporting the urethra, that was preventing leakage. So you can then have leakage after you take the bulge away. And so you want to know that before you go through with any sort of surgery, rather than finding out after the fact.

What are the treatment options?

Number one is pelvic floor physical therapy or doing things like Kegel exercises. Doing them by yourself at home is like going to the gym by yourself. The best thing to do is actually to go to a pelvic floor physical therapist who can guide you, like your personal trainer at the gym, in doing the right exercises. They’ll work with you on things like making sure your pelvis is aligned, and also making sure that you’re squeezing the right muscles, and you’re improving week to week.

Another option is a pessary. So I briefly talked about this before, but the pessary comes in all sorts of different shapes and sizes, usually silicone, and it’s inserted in the vagina to hold up the prolapse. And it can be removed either daily by you or every few months, usually around every three months, by your gynecologist or urologist.

And lastly, there’s surgeries. Now, prolapse surgeries, there are multiple different kinds of surgeries depending on the type of prolapse you had. But generally speaking, you can do vaginal surgery, meaning that you typically make an incision in the area of the prolapse and rebuild the pelvic floor, and this usually will include whatever compartment, meaning anterior, apical, or posterior, are involved in the Vaginal prolapse.

Another alternative is to do a robotic or abdominal surgery, where you go in and you actually suspend either the vagina or the uterus or remove the uterus and suspend the vagina so that it’s now holding everything up in its normal position using mesh or using suture to hold up the very top of the vagina.

Conclusion

Now, there are many risks and benefits of all these options, but it’s absolutely very important to talk to your doctor about the risks and benefits, know what to expect after surgery, how long recovery is going to be. Usually what prescribed to patients is at least four weeks, no heavy lifting, and that could be up to six weeks. So it’s really important to talk to your doctor about the risks, benefits, any questions you may have about surgery before proceeding with them.

You need to be super comfortable with your surgeon. If you’re not, please seek a second opinion, talk to somebody else, because even doctors want their patients to like them and want to work with them. So it makes their jobs easier that doctors know that they are all on the same page.

And lastly, it’s important to remember that it’s okay to do nothing if you’re not having symptoms and you’re feeling fine. It’s really okay to do nothing. People often ask like, what is it going to get worse? But unfortunately, doctors don’t have the answer to that.

When you look at studies of people who are followed over time who choose not to have surgery on their first visit, then usually about 20 percent of them will go on to have surgery later. But we don’t know exactly who that’s going to be. Ultimately, there’s no way to tell for sure that you’re going to get worse or need surgery later down the line.

So you should really do what you feel is best for you at that moment in time. The last thing we want to leave you with is, it is seen so many people who wait for their care for so, so long. They take care of their children, they take care of their spouse, and by the time they’re finally at the urologist, they are… You know, they’ve been waiting and dealing with this for years. Don’t let that be you. It’s okay to prioritize yourself and get help. If you enjoyed this video and you want to learn more about issues that can affect women with weak pelvic floors, check out my video on stress urinary incontinence, where I talk all about that and what you can do about that as well. As always, remember to take care of yourself, because you’re worth it.