Vaginal Prolapse

Introduction

• Description: Vaginal prolapse is the loss of the normal support mechanism, resulting in descent of the vaginal wall down the vaginal canal. In the extreme, this may result in the vagina becoming everted beyond the vulva to a position outside the body. Vaginal prolapse is generally found only after hysterectomy and is a special form of enterocele.

• Prevalence: Depends on the severity of the original defect, type of surgery originally performed, and other risk factors (estimated to be between 0.1% and 18.2% of patients who have undergone hysterectomy).

• Predominant Age: Late reproductive age and older.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Loss of normal structural support because of trauma (childbirth), surgery, chronic intraabdominal pressure elevation (eg, obesity, chronic cough, or heavy lifting), or intrinsic weakness. A recurrence within 1–2 years of surgery is considered a failure of technique.

• Risk Factors: Birth trauma, chronic intraabdominal pressure elevation (eg, obesity, chronic cough, or heavy lifting), intrinsic tissue weakness, or atrophic changes resulting from estrogen loss.

Signs and Symptoms

• Pelvic pressure or heaviness, backache

• Mass or protrusion at the vaginal entrance

• New-onset or paradoxical resolution of urinary incontinence

Diagnostic Approach