Vaginal Prolapse Diagnosis & Treatment
Very rarely is a woman's life in danger from a vaginal prolapse, although prolapses usually get worse with time. For this reason, it's wise to act promptly when symptoms first appear.
The best way to diagnose vaginal prolapse is through a physical examination and a review of the woman's medical history. Usually a physician examines each section of the vagina separately, requiring the woman to sit upright to make any prolapsed tissues more easy to find.
Cystocele or rectocele are more easily discovered by a physical examination than are vaginal vault prolapse or enterocele. The examining physician may use a variety of tests for diagnosis, including a urodynamics procedure, an exam of the urethra-bladder neck, and an investigation of the strength of the pelvic floor.
The physician may also order a magnetic resonance imaging (MRI) scan, an ultrasound exam or conduct cystourethroscopy, in which a small tube is inserted into the urethra for internal viewing of the urethra and bladder.
Some women are candidates for nonsurgical treatment, including women who are not sexually active, cannot undergo surgery, or experience few symptoms. These women may benefit from estrogen replacement therapy to help strengthen vaginal muscles.
For others, surgery is likely the best option. Today laparoscopic surgery is common for securing the vaginal vault after a hysterectomy and correcting some types of vaginal prolapse such as enteroceles or uterine prolapses.
Physical therapy can help strengthen the muscles in the pelvis of a sufferer of vaginal prolapse. There are two kinds:
- Biofeedback employs a sensor to monitor muscle activity in the vagina and on the pelvic floor. Certain exercises can strengthen these muscles, sometimes enough to reverse or relieve symptoms. In addition, the sensor can monitor muscular contractions during the exercises, indicating to a physician if the exercises might be effective.
- Electrical stimulation involves a probe which a physician applies to targeted muscles within the vagina or on the pelvic floor, delivering small electrical currents. The electricity causes the muscles to contract and strengthen.
Surgery for vaginal prolapse
Surgical treatments vary with the type of prolapse and usually require from two to four days of hospitalization. After surgery, a patient should avoid heavy lifting for from six weeks to two months.
A surgeon operating for cystocele and rectocele works through the vagina, usually with an incision in the vaginal wall in order to push the organ up and back into place. The surgeon then secures the vaginal wall to fix the organ in its normal position and next removes any excess tissue before closing the vaginal wall. If the patient is suffering from urinary incontinence, the surgeon may need to support the urethra through a procedure called a bladder neck suspension.
For vaginal vault prolapse, which takes place high in the vagina, a surgeon may work through either the vagina or abdomen, the latter being for severe cases. In most surgeries of this type, the surgeon uses a technique called a vaginal vault suspension, in which the vagina is attached to strong tissue in the pelvis or to the sacrum, a bone at the base of the spine.
In the case of a prolapsed uterus, women who are postmenopausal or do not want to have more children usually undergo a hysterectomy. The common approach for this procedure is through the vagina.