What is Vaginal Vault Prolapse?
Many women have never heard of vaginal prolapse (vaginal vault prolapse). One reason for the lack of discussion is that it can bring an element of shame and thus, confusion of what exactly it is and what can be done about it. A vaginal prolapse happens when there is drooping of the upper portion of the vagina into the vaginal canal or outside the vaginal opening. It occurs when the tissues and muscles that support the vagina weaken or become damaged, leading to a loss of vaginal support and resulting in a slip of the vaginal vault.
Types of Vaginal Vault Prolapse
Many women can present a vaginal vault prolapse at varying degrees. Clinically speaking, the condition can be categorized based on the extent and severity of the prolapse:
- First-Degree Prolapse: The vaginal vault descends into the upper portion of the vaginal canal.
- Second-Degree Prolapse: The vaginal vault descends to or beyond the vaginal opening but does not protrude outside the body.
- Third-Degree Prolapse: The vaginal vault protrudes outside the vaginal opening, sometimes reaching the point where it is visible or palpable.
Who is at risk for vaginal Vault prolapse?
Vaginal vault prolapse typically affects women who have undergone a hysterectomy, regardless of age. However, there are other contributing risk factors for developing vaginal vault prolapse such as:
Older age
As women age, the tissues and muscles of the pelvic floor naturally weaken, making them more susceptible to vaginal vault prolapse.
Post-menopause
Age is often associated with menopause, but hormone deficiencies can happen for varying reasons. The decrease in estrogen can contribute to the thinning of the vaginal wall causing it to weaken.
Multiple vaginal deliveries
Women who have given birth vaginally, particularly multiple times or with complicated deliveries, may have a higher risk of developing vaginal vault prolapse.
Smoking
Smoking tobacco was found to correlate with a severe degree of vaginal prolapse significantly.
Obesity
A high BMI can increase intra-abdominal pressure that weakens the pelvic floor muscles and fascia
Pregnancy
Increased cortisol and progesterone levels may contribute to uterine relaxation.
Pelvic floor weakness
Pelvic floor weakness is often caused by chronic straining. The pelvic floor muscles and ligaments that support the vagina may weaken over time due to factors such as aging, childbirth, or hormonal changes, increasing the risk of vault prolapse.
- Constipation
- Chronic cough
- Frequent vomiting
- Often lift heavy things improperly
Connective tissue disorders
Certain connective tissue disorders, such as Ehlers-Danlos syndrome or Marfan syndrome, can weaken the supportive structures of the pelvic floor and contribute to vaginal vault prolapse.
Hysterectomy
As mentioned, hysterectomy is often associated as the cause of vaginal vault prolapse. A hysterectomy is the surgical removal of the uterus and especially when it is performed through the vaginal approach, can disrupt the normal support system of the vagina, leading to a higher risk of vault prolapse.
Symptoms of Vaginal Vault Prolapse
The symptoms for vaginal vault prolapse can vary and sometimes not present at all. More often, vaginal vault prolapse symptoms start slow and are more obvious over time. A pelvic floor physical therapist, urogynecologist, or an ob-gyn who specializes in pelvic floor disorders can find vaginal prolapse in routine exams.
Knowing the symptoms is the best way to advocate for yourself in diagnosing vaginal prolapse early. Below are some common symptoms associated with vaginal vault prolapse, but are also common to other pelvic floor dysfunctions. It is important to consult a healthcare professional for a proper diagnosis:
- Urinary symptoms, such as increased frequency, urgency, leakage or not being able to empty the bladder completely.
- You may have back pressure or pain.
- Painful or uncomfortable sexual intercourse
- You may feel laxity within the vagina, or you may have more difficulty reaching orgasm.
- Vaginal/pelvic pressure
- More with prolonged standing/walking
- Difficulty passing bowel movements, such as constipation or incomplete emptying
- Pelvic Pain
- The sensation of pressure or heaviness in the pelvic region.
- Bulging or protrusion in the vaginal area.
When to see a Physician for Vaginal Vault Prolapse
It is important to consult a healthcare provider if you suspect you have vaginal vault prolapse or experiencing symptoms that suggest its presence. Seeking medical attention promptly allows for an accurate diagnosis and timely intervention. Here are some specific situations in which you should consider seeing a physician:
Persistent or Worsening Symptoms
If you are experiencing persistent or worsening symptoms associated with vaginal vault prolapse, such as pelvic pressure, bulging sensation, or discomfort during intercourse, it is advisable to consult a healthcare provider. These symptoms may indicate a significant prolapse or progression of the condition.
Impact on Daily Life
If vaginal vault prolapse interferes with your daily activities, such as work, exercise, or sexual function, it is essential to seek medical evaluation. The symptoms may affect your quality of life, and appropriate treatment can help alleviate these limitations.
Difficulty with Urinary or Bowel Function
Any changes in urinary or bowel function, such as urinary incontinence, difficulty emptying the bladder or bowels, or recurrent urinary tract infections, may indicate vaginal vault prolapse. Consulting a healthcare provider is essential to assess the extent of the prolapse and address associated functional concerns.
Concerns about Prolapse Recurrence
If you have previously undergone surgical treatment for vaginal vault prolapse and are experiencing a recurrence of symptoms, it is important to see a physician. Recurrence can occur, requiring further evaluation to determine the extent of the prolapse and explore additional treatment options.
Impact on Emotional Well-being
Vaginal vault prolapse can have a significant emotional impact, leading to embarrassment, self-consciousness, or reduced self-esteem. If you are experiencing emotional distress related to your prolapse, it is advisable to seek professional support. A healthcare provider can offer guidance, reassurance, and resources to address the emotional aspects of living with vaginal vault prolapse.
Remember, timely evaluation and treatment of vaginal vault prolapse can help manage symptoms, improve quality of life, and prevent potential complications. A healthcare provider specializing in pelvic floor disorders, such as a urogynecologist or a pelvic floor physical therapist, can provide a comprehensive assessment, accurate diagnosis, and appropriate treatment options tailored to your specific needs. Don't hesitate to reach out and seek the support you need to optimize your pelvic floor health.
Treatments for Vaginal Vault Prolapse
The treatment options for vaginal vault prolapse depend on the severity of the prolapse, the impact on symptoms, and individual patient preferences. Treatment approaches may include:
Pelvic Floor Exercises
Pelvic floor exercises can help strengthen the pelvic floor muscles and support the uterus. You can work with a pelvic floor physical therapist to create a custom exercise plan. Another great supplement to in-person physical therapy is an at-home program that can help keep you on track with your daily exercises. Every Mother's app-based proven program offers pelvic floor muscle training guided by pelvic PTs to help reduce symptoms while improving strength, and function in the core and pelvic floor.
Lifestyle Modifications
Maintaining a healthy weight can reduce the strain on the pelvic floor muscles. One contributing factor to uterine prolapse is weight gain. Excess weight can stretch the muscles and connective tissue on top of the abdomen. This inward pressure is extremely similar to the strain on the abdominal wall during the later stages of pregnancy.
Pessary Use
A pessary, a removable device inserted into the vagina, can support the vaginal vault and alleviate symptoms. It is fitted by a healthcare provider and requires regular follow-up visits to ensure proper placement and comfort.
Surgical Intervention
Depending on the severity of the vaginal vault prolapse and the impact on symptoms, surgical intervention may be recommended. Surgical options aim to restore and repair the supportive structures of the pelvic floor, such as ligaments and tissues. The specific procedure will be determined based on individual factors and can range from vaginal approaches to minimally invasive or open abdominal procedures.
Frequently Asked Questions (FAQ) about Vaginal Vault Prolapse
Can vaginal vault prolapse be prevented?
While it may not always be possible to prevent vaginal vault prolapse, certain measures can help reduce the risk or delay its onset. These include maintaining a healthy weight, practicing healthy pelvic floor muscle health through regular exercises, avoiding heavy lifting, and managing conditions that can weaken the pelvic floor, such as chronic constipation.
Will sexual intercourse worsen vaginal vault prolapse?
Sexual intercourse itself does not directly worsen vaginal vault prolapse. However, if you experience discomfort or pain during sexual activity due to prolapse, it is advisable to consult a healthcare provider. They can evaluate your specific situation and guide managing symptoms and improving sexual comfort.
Can vaginal vault prolapse recur after treatment?
Recurrence is possible, particularly if underlying risk factors are not adequately addressed. However, following recommended treatment plans, including lifestyle modifications, pelvic floor exercises, and regular follow-up visits with your healthcare provider, can help reduce the likelihood of recurrence.
Can I still have a vaginal delivery if I have a history of vaginal vault prolapse?
The decision regarding vaginal delivery should be made in consultation with your healthcare provider, considering the severity of the prolapse, associated symptoms, and individual circumstances. In some cases, vaginal delivery may be possible, while in others, cesarean delivery may be recommended to minimize the risk of worsening the prolapse.
It is important to note that some individuals may experience multiple types of pelvic organ prolapse simultaneously. Being open and honest with your healthcare provider regarding any concerns or questions you may have about vaginal vault prolapse can alleviate any anxiety you may have and also diagnose vaginal vault prolapse early.
A pelvic floor physical therapist, urogynecologist, or an ob-gyn who specializes in pelvic floor disorders can provide a comprehensive evaluation, discuss treatment options, and develop a tailored plan to address your needs and optimize your pelvic floor health.
Sources:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217878/
- https://www.healthline.com/health/womens-health/vaginal-prolapse
- https://www.acog.org/womens-health/experts-and-stories/the-latest/5-things-i-wish-all-women-knew-about-pelvic-organ-prolapse
