Definition

Vaginal prolapse is the inward and downward bulging of the vaginal walls. The severity of vaginal prolapse may be defined as:

• First degree—collapse into the upper part of the vagina
• Second degree—collapse further into the vaginal canal, down to the level of the vaginal opening
• Third degree—collapse that extends beyond the opening

Causes

Vaginal prolapse is caused by weakened support structures in the pelvic region. The lack of support causes the walls of the vagina to weaken, sag, and collapse.

Risk Factors

Your chances of vaginal prolapse increase with age. Other factors include:

• Multiple vaginal deliveries
• Post-menopause
• Obesity
• Straining caused by chronic cough, constipation, or heavy lifting
• Family history

Symptoms

Symptoms may include:

• Pelvic pressure
• A feeling of vaginal fullness or heaviness
• A feeling of pulling in the pelvis
• Vaginal discomfort
• Urinary urgency and frequency
• Urination when laughing, sneezing, coughing, or exercising
• Constipation
• Difficult or painful intercourse
• Low backache that is relieved with lying down

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Vaginal prolapse that has no symptoms may be diagnosed during routine examinations. You may be referred to a gynecologist, who will do a pelvic exam.

Treatment

Talk with your doctor about the best treatment plan for you. First or second degree prolapse without symptoms may not require treatment. Treatment options include:

Prevention

To help reduce your chance of vaginal prolapse:

• Do Kegel exercises.
• Maintain a healthy weight.
• To avoid constipation, eat plenty of fruits, vegetables, and whole grains. Drink plenty of fluids throughout the day.
• If you smoke, talk to your doctor about ways to quit. Smoking may cause chronic coughing and weakening of connective tissues.
• Limit heavy lifting.

Office on Women’s Health http://www.womenshealth.gov

Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

Pelvic organ prolapse. International Urogynecological Association website. Available at:
http://c.ymcdn.com/sites/www.iuga.org/resource/resmgr/Brochures/eng_pop.pdf
Accessed April 22, 2013.

Uterine and vaginal prolapse. The Merck Manual Professional Edition. Available at:
http://www.merckmanuals.com/professional/gynecology_and_obstetrics/pelvic_relaxation_syndromes/uterine_and_vaginal_prolapse.html
Updated December 2013. Accessed March 18, 2014.

Vaginal pessary. American Academy of Family Physicians Family Doctor website. Available at:
http://familydoctor.org/familydoctor/en/drugs-procedures-devices/procedures-devices/vaginal-pessary.html
Updated August 2010. Accessed April 22, 2013.

5/11/2009 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Fritel X, Varnoux N, Zins M, Breart G, Ringa V. Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors. Obstet Gynecol. 2009;113:609-616.