Vaginal Prolapse

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Overview

Vaginal prolapse, also called pelvic organ prolapse, occurs when an organ in the pelvis (e.g., uterus, urethra, bladder) or the top portion of the vagina (called the vaginal vault) drops down into or protrudes through (herniates) the vagina. Muscles, ligaments, and other structures around the vagina help support the pelvic organs, keeping them in place. Vaginal prolapse can occur when this support system weakens or is damaged.

Types of pelvic organ prolapse include the following:

• Cystocele (bladder prolapse)
• Enterocele (small bowel prolapse)
• Rectocele (rectum prolapse)
• Uterine prolapse (prolapse of the uterus)
• Vaginal vault prolapse

Cystocele occurs when the front of the vaginal wall weakens, allowing the bladder to herniate into the vagina. This condition changes the angle of the urethra (tube that carries urine from the body) and often results in stress incontinence. When a cystocele occurs, the urethra also may prolapse into the vagina (called urethrocele). When prolapse of both the bladder and the urethra occurs, the condition is called cystourethrocele.

Enterocele is a condition that occurs when the front and back vaginal walls separate, allowing the small bowel to press against or herniate into the vagina. This condition is more common following removal of the uterus (hysterectomy).

Rectocele, which also may be called proctocele, occurs when the back of the vaginal wall weakens and the rectum presses against or prolapses into the vagina. This condition may create a bulge that is more noticeable during a bowel movement.

Weakening of the ligaments that support the top of the vagina (called the uterosacral ligaments) may cause the front and back of the vaginal walls to weaken as well, resulting in prolapse of the uterus (womb). There are 3 stages of this condition, which is called uterine prolapse:

• First-degree (the bottom portion of the uterus enters the vaginal canal)
• Second-degree (the uterus enters the lower portion of the vagina)
• Third-degree (the uterus protrudes through the vaginal opening)

The uterus, or womb, helps to support the top of the vagina. Following removal of the uterus (hysterectomy), the upper portion of the vagina (vaginal vault) may drop toward the vaginal opening. This condition, which is called vaginal vault prolapse, occurs in about 10% of women who have had a hysterectomy. Vaginal vault prolapse often occurs with enterocele.

Incidence and Prevalence
Approximately 30–40% of all women experience pelvic organ prolapse. The condition occurs most often in women over the age of 40. It is more common in women who have given birth, women who have experienced menopause, and women who have had a hysterectomy (removal of the uterus).

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