Vaginal Bulge
Bladder Prolapse
Overview
Vaginal prolapse is a common condition that affects women. Prolapse, which is much like a hernia into the vagina, is caused by weakness in the support to the vagina that allows the vagina to bulge down. This can occur in different areas of the vagina.
There are many potential causes for a bladder prolapse. The most common causes are childbirth and pregnancy. Additional causes include chronic coughing, lifting heavy objects, frequent constipation, and genetic pelvic floor weakness.
Mild and moderate cases can often be treated with non-surgical interventions. However, severe cases of bladder prolapse may require surgery to keep vital pelvic organs in their correct positions.
Symptoms
There are several common symptoms that are present in most cases of prolapse. These symptoms include:
- A feeling of pressure or fullness in the pelvis and vagina
- A bulge of tissue in the vagina that is visible
- Increase in pelvic pressure when coughing, straining, or lifting
- Difficulty urinating or starting a stream of urine
These symptoms tend to be most prevalent after standing up for extended periods of time. Signs of prolapse may fade away when patients lie down.
Diagnosis
There are several ways to diagnose a prolapse. These include:
Pelvic Exam
The most effective way of diagnosing a prolapse is through a pelvic exam. You may be examined while standing or while lying down. During the examination, your physician will look for a visible tissue bulge in your vagina. A bulge is a strong indicator of prolapse.
Your doctor will likely ask you to exert yourself as if you are having a bowel movement. This allows them to determine how much that action impacts the degree of your prolapse. They will also ask you to contract your pelvic muscles so that they can check for normal strength.
Questionnaire
Your physician may provide you with a questionnaire so that they can assess how much the prolapse is affecting your overall quality of life. This will guide their treatment.
Urine and Bladder Tests
Patients with a significant prolapse may not be able to adequately empty their bladders. If your physician is concerned that your prolapse is severe, then they may run tests on your urine to check for bladder infections.
Treatment
The right treatment for you will depend on the severity of your prolapse as well as your symptoms. Patients that are experiencing severe discomfort and urinary incontinence will likely require surgical intervention. Milder cases can be treated with non-invasive options.
The three primary treatment options include:
Pelvic Floor Therapy
Pelvic floor muscles exercises are a great way of providing added support to your pelvic organs. These exercises are successful at relieving many milder symptoms of prolapse when performed correctly. Your doctor or a licensed physical therapist can provide you with detailed instructions on how to perform these exercises.
For more information visit:
https://sufuorg.com/docs/oab/oab-pelvic-floor-muscle-training.aspx
Pessary
A pessary is a supportive device that is inserted into your vagina. It is a rubber or plastic ring that offers added support to relieve prolapse symptoms. Typically your gynecologist will show you how to clean the device and reinsert it without assistance. These devices can buy time and allow you to delay surgery.
Surgery
Surgical treatment for prolapse can be preformed vaginally or abdominally. During the procedure, the physician will hold the bladder into place with stitches or mesh. They will also remove excess vaginal tissue, if necessary.
In some cases, a hysterectomy is performed at the same time in conjunction with a gynecologist.
Colpocleisis (vaginal closure) is a vaginal procedure, which corrects prolapse by suturing the front and back walls of the vagina together to prevent any vaginal bulging. This procedure is done under general anesthesia. A hysterectomy does not have to be performed with this procedure. A colpocleisis is on suitable in women who are not sexually active, as the vaginal canal will be closed off. This procedure is an outpatient procedure and is particularly suitable for women with medical problems, which may make them less suitable for longer and more complex procedures. It is associated with high success rates of 90-95%. This procedure can be done in conjunction with procedures to treat stress incontinence.
What to expect afterwards:
- Vaginal bleeding similar to a heavy to moderate period is normal for several weeks after surgery.
- Some pelvic pressure or discomfort is common. If severe, let your doctor know.
- You will be instructed to do no heavy lifting, intercourse, bathing or swimming in a pool for 6 weeks.
- You may shower the next day, drive when you are no longer on pain medicine and moving your legs normally, and resume normal daily activities as tolerated.
- No baths until seen by your urologist for follow-up in the office.
Sacrospinus ligament fixation is a vaginal procedure to attach the top of the vagina or cervix to pelvic ligament (sacrospinus ligament) with a permanent stitch. This stitch is supported by piece of biologic tissue. This procedure is done under general anesthesia. A hysterectomy does not have to be performed at the time of surgery. Often you are kept overnight after surgery with a catheter and packing that is inserted vaginally to prevent bleeding. You will typically be in the hospital overnight and be able to leave once the packing and catheter are removed and you can empty your bladder. This procedure is associated with success rates of 80-90%. This procedure can be done in conjunction with procedure to treat stress incontinence.
What to expect afterwards:
- Vaginal bleeding similar to a heavy to moderate period is normal for several weeks after surgery.
- Some pelvic pressure or discomfort is common. If severe, let your doctor know.
- You will be instructed to do no heavy lifting, intercourse, bathing or swimming in a pool for 6 weeks.
- You may shower the next day, drive when you are no longer on pain medicine and moving your legs normally, and resume normal daily activities as tolerated.
- No baths until seen by your urologist for follow-up in the office.
Sacrocolpopexy is an abdominal procedure that correct prolapse by attaching a piece of mesh to the top of the vagina or cervix to a ligament in the sacrum (low back). This procedure is typically done robotically utilizing multiple small incisions. This procedure has best results in patients who have already had a hysterectomy or undergoing a hysterectomy at the time of this procedure. You are kept overnight after surgery with a catheter in place. You will typically be in the hospital overnight and be able to leave once the catheter is removed and you canempty your bladder. This procedure is associated with high success rates of 90-95%. This procedure can be done in conjunction with procedure to treat stress incontinence.
What to expect afterwards:
- Vaginal bleeding similar to a heavy to moderate period is normal for several weeks after surgery.
- Some pelvic pressure or discomfort as well as abdominal discomfort is common. If severe, let your doctor know.
- You will be instructed to do no heavy lifting, intercourse, bathing or swimming in a pool for 6 weeks.
- You may shower the next day, drive when you are no longer on pain medicine and moving your legs normally, and resume normal daily activities as tolerated.
- No baths until seen by your urologist for follow-up in the office.
FAQ's
A prolapse is a hernia of a woman’s vagina. It often presents as pressure or a distinct bulge. It is referred to by many different terms, including a bladder prolapse cystocele, dropped uterus, or dropped rectum.
Prolapse is attributed to a weakening of vaginal tissues. It is often associated with childbirth and pregnancy but prolapse can occur in women that have no children. A chronic cough, heavy lifting, and poor tissue health can also contribute to prolapse.
Prolapse is often characterized by discomfort, but it is generally non-life-threatening. There are several treatment options available.
Most women elect to use conservative treatments that include pelvic floor muscle exercises, dietary changes, and physical therapy. However, some women experience significant discomfort and opt for surgical intervention.
Mild cases of bladder prolapse can effectively be treated with conservative methods. However, prolapse that is not addressed will usually get worse over time. Surgical treatment is the best way to address prolapse.
Hysterectomies are not a mandatory part of prolapse treatment. However, many physicians recommend undergoing both procedures at the same time. Removing the uterus makes it easier to repair the prolapse. A hysterectomy may also be necessary to address other issues, such as excessive vaginal bleeding.
Unfortunately, no surgical intervention has a 100% success rate. Roughly 5% to 15% of women experience a failure after prolapse surgery. Most of the time, these are partial failures that require a minor corrective procedure, no treatment, or the use of a pessary (intervaginal device).