Vaginal prolapse
definition
A vaginal prolapse, also known as a vaginal prolapse, is a protrusion of the vagina from the vaginal entrance. If the vagina goes deeper without a protuberance, this is called a sagging of the vagina (Descensus vaginae) designated. In addition to the sagging of the vagina, the uterus can also sag, which can also fall out through the vagina. These clinical pictures often appear together.
The trigger is a pelvic floor weakness or an increase in pressure in the abdomen and occurs more frequently with increasing age.
causes
A vaginal prolapse usually affects women who have already given birth. This can damage the holding apparatus of the vagina and cause nerve damage. In addition, pelvic floor weakness, which is either congenital or a result of menopause, can lead to vaginal sagging and resulting prolapse.
Long-term improper or overstressing of the pelvis can also be accompanied by weakness of the muscles and ligaments there.
Another cause of a vaginal prolapse is increased pressure in the abdomen. This is caused, for example, by obesity, chronic cough or constipation.
Vaginal prolapse after childbirth
Childbirth is a common cause of a vaginal prolapse. A pelvic floor weakness can arise particularly in traumatic births, in which there is massive overstretching and damage to the structures of the pelvis. Because of this weakness, the genital organs can sink and fall out through the vagina. The uterus or the vagina can be affected.
After a vaginal birth, irritation of the nerves can also lead to a temporary sinking of the genital organs, which regresses by itself when the nerves recover. Risks include multiple births, a long period of expulsion, and mechanical labor complications. A perineal incision can prevent the risk of subsidence by relieving pressure and reducing the likelihood of tearing.
Vaginal prolapse after removal of the uterus
After removal of the uterus (hysterectomy) the vagina may sag or prolapse. The uterus is anchored in the pelvis using various support structures. Since the vagina is connected to the uterus, they support each other. If the uterus and its attachments are removed, the vagina can lose its hold and sink downwards.
diagnosis
The diagnosis of a sagging or prolapsed vagina is usually made by the gynecologist. This can assess the decrease or the incident in a vaginal examination. If there is only a slight depression, this can be made visible by the patient's coughing or pressing. A tactile examination also provides information about the location and extent. In addition, a vaginal ultrasound is carried out, as well as examinations of the urinary bladder and rectum, in order to detect possible accompanying symptoms such as bladder or bowel emptying disorders at an early stage.
Concomitant symptoms
If the vagina sinks down, there is a feeling of pressure in the perineal region. A feeling of foreign body arises, which is described as "something is falling out of the vagina". Furthermore, there may be a pulling in the lower abdomen or lower back. Pain is rather rare.
If the anterior vaginal wall is weak, this is often accompanied by a sagging of the urinary bladder, which is known as Cystocele referred to as. The bladder turns out into the front wall of the vagina. As a result, incontinence usually occurs. This manifests itself particularly under stress, for example through coughing or sneezing. Urinary tract infections and urinary tract infections also occur.
If the posterior vaginal wall is weak, this is often associated with a rectocele. The rectum falls forward towards the vagina. This clinical picture is accompanied by defecation disorders with incontinence, a weak sphincter or constipation. Symptoms can be provoked by coughing or straining.
therapy
When treating sagging or prolapsed vagina, there are a few factors to consider. There is a division into four degrees of severity, because depending on the intensity, conservative therapy is possible or an operation makes sense. The age of the patient and accompanying illnesses are also relevant. Because an operation can involve more risks in older or previously ill women. If there is a desire to have children, this must be taken into account in an operative procedure.
If there is only a slight depression, this can be treated with pelvic floor exercises. Local estrogen treatment in the form of ointments can also be helpful. A pessary is recommended for transitional treatment or in the event of inoperability. This is a ring or cube that is inserted into the vagina by the gynecologist and is intended to support the organs. This method is very effective for treating symptoms, but is not a causal therapy.
The first choice therapy is surgery.
surgery
Surgery is the first line treatment for a vaginal prolapse. The standard procedure is surgery through the vagina. This typically involves removing the uterus, tightening the pelvic floor and the associated ligaments, and removing excess vaginal tissue. The remaining vaginal stump is closed and attached to the sacrum. This prevents it from falling again.
If there is a desire to have children, the sinking is only slightly pronounced or if an isolated cystocele or rectocele is present, a pelvic floor surgery alone can be performed. In recent years, the use of Vicryl or polypropylene nets has also proven successful.
If an operation from the vaginal area is not possible, a small incision is made from the abdomen. Which surgical method is the best is decided on the basis of the anatomical conditions, the degree of subsidence and individual risk factors.
forecast
The prognosis depends on the stage of vaginal sagging and involvement of other organs. In principle, surgery is superior to conservative therapy. However, it can fall again despite surgery. To prevent a decrease, regular exercise and pelvic floor exercises are recommended. Furthermore, lifting heavy loads should be avoided if possible.
