Why Does It Feel Like My Vagina is “Falling Out”
Pelvic organ prolapse is a benign condition in which the pelvic floor muscles and tissues can no longer support the pelvic organs, resulting in them dropping down. It is reported that pelvic organ prolapse occurs in about 3% of women. Pelvic disorders as a whole are extremely common, with 1 in 5 women experiencing a Pelvic disorder of some sort during their life. These can include things such as urinary incontinence, faecal incontinence and prolapse.
Risk factors for developing a pelvic organ prolapse include things such as trauma to the pelvic muscles, for example that occurs due to stretching during pregnancy, especially during the 2nd stage of labour. It is also thought that the menopause can cause increased risk because of the loss of estrogen, which results in the loss of tissue elasticity. Other factors include repeated heavy lifting, hysterectomies and things that create pressure in the abdomen, such as being overweight or having a chronic cough.
There are different types of pelvic organ prolapse: Cystocele, uterine, vaginal-vault and rectocele. A cystocele prolapse (or anterior vagina wall prolapse) affects the bladder. A uterine prolapse affects the uterus and may also be accompanied by the prolapse of the small intestine (called an anerocele). A vaginal vault prolapse affects the top section of the vagina, and a rectocele prolapse (or anterior vaginal wall prolapse) affects the rectum.
Symptoms of pelvic floor prolapse can be gradual and range from mild to severe, with many women not even realising they have had one. A severe prolapse is defined as the state where the organs have pushed out of the vaginal opening. Some possible symptoms include feeling a bulge in your vagina, feeling pressure in your pelvis, leaking of urine, difficulty when emptying urine, sexual dysfunction and back pain. These symptoms can have huge effects on the quality of life for many women.
Getting diagnosed with a pelvic organ prolapse requires a visit to your healthcare provider where you will be examined (which may involve you being asked to cough or bare down) and you will then likely be referred to a gynaecologist for further evaluation.
Upon examination, the prolapse will be staged using the following criteria:
Stage 0 – No prolapse
Stage 1 – The most distal point of the prolapse is more than 1cm above the level of the hymen
Stage 2 – The most distal point of the prolapse is between 1cm above the level of the hymen and 1cm below the level of the hymen (would be seen to be sticking out about 1cm through the vaginal entry)
Stage 3- The prolapse extends more than a cm below the level of the hymen but not more than 2cm of the total vaginal length
Stage 4 – total/complete vaginal eversion
Treatment of pelvic floor prolapse depends on the case. Many women do not actually need treatment and it is used in cases where the symptoms are particularly troublesome and is having detrimental effects.
Simple treatments are focused on preventing the further progression of the prolapse. Kegel exercises are an example of this and are also good for helping with incontinence. Other changes that can be made include limiting fluid intake, as well as reducing alcohol and caffeine. Some women may also see a pelvic floor physiotherapist, which is a highly specialised physiotherapist trained to treat the pelvic floor muscles both internally and externally. (See the previous blog post all about this!)
Another non-surgical option is a pessary which can be inserted and works to help support the organs from the inside, it can be great for sort term of long-term management, however it does not work for everyone. Finally, if all else fails, surgery may be considered.
There are two types of surgery for pelvic organ prolapses. The first involves repairing the prolapse and consists of the organs being restored as close to their original position as possible and being supported by a sling or surgical mesh. The second type involves the shortening, narrowing, or complete closing off of the vagina. This, in turn, creates support for the prolapsed organs, however, may mean that vaginal intercourse is no longer possible following the procedure.
With both of these types, there is still risk of the prolapse returning. This risk is increased if the surgery is done either before the age of 60, you are overweight, or have a very severe prolapse.
Some lifestyle changes to decrease the amount of pressure being put on your pelvic floor include decreasing constipation by increasing your fibre and water intake, and using stool softeners if you do experience constipation. It is also good practice to have your legs raised on a stool when doing bowel movements to reduce pelvic muscle strain.
There may be extra pressure being put on the pelvic floor from excess bodyweight, so losing weight can also reduce this. Reducing smoking can also reduce pressure through reducing pressure from smoker’s cough.