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Types of Prolapse

Anterior Vaginal Prolapse (also known as cystocele)
This type of prolapse occurs when the wall between the vagina and the bladder stretches or detaches from its attachment on the pelvic bones. This loss of support allows the bladder to prolapse or fall down into the vagina.

Most women do not have symptoms when the anterior vaginal prolapse is mild. As it progresses outside the opening of the vagina, the prolapsed bladder may not empty well which can lead to urinary frequency, night time voiding, loss of bladder control and recurrent bladder infections. Strengthening pelvic muscles may improve the support to the bladder and neighboring organs and reduce symptoms. In addition, women can get temporary support by wearing a device called a vaginal pessary. It works much like a knee or ankle brace would support a weak joint. When these efforts are inadequate surgery is available to elevate the bladder and other internal organs to their proper position.

Posterior Vaginal Prolapse (also known as rectocele)
Weakening and stretching of the back wall of the vagina allows the rectum to bulge into and out of the vagina. Most often, the damage to the back wall of the vagina occurs during vaginal childbirth, although not everyone who has delivered a child vaginally will develop a rectocele. Mild rectoceles rarely cause symptoms. However, straining with constipation puts significant pressure on the weak vaginal wall and can further thin it out. Avoiding constipation may prevent progression and also reduce symptoms from the rectocele. Some women may find benefit from pelvic floor muscle strengthening and vaginal pessaries. When these low risk interventions are insufficient to relieve symptoms, surgery is performed to reinforce the posterior vaginal wall. This picture shows what a rectocele looks like from the outside.

Uterine Prolapse
When the supporting ligaments and muscles of the pelvic floor that keep the uterus in the pelvis are damaged, the cervix and uterus descend into and eventually out of the vagina. Often, uterine prolapse is associated with loss of vaginal wall support (cystocele, rectocele). When the cervix protrudes outside the vagina, it can develop ulcers from rubbing on underwear or protective pads. There is a risk that these ulcers will bleed and become infected. This picture shows what uterine prolapse looks like from the outside. As with other forms of prolapse, it is not until the uterine descent is bothersome that treatment is necessary. Women who have uterine prolapse often report pelvic pressure, the need to sit or lay down to relieve the discomfort, a sensation that their insides are falling out, difficulty emptying their bladder and urine leakage. Strengthening the pelvic muscles with Kegel exercises, avoiding heavy lifting, constipation, and weight gain may reduce the risk of progression of uterine descent. Additional treatment options include pessary devices which provide support when worn or surgery.

Vaginal Prolapse after Hysterectomy
If a woman has already had a hysterectomy, the very top of the vagina (where the uterus used to be) can become detached from its supporting ligaments. This can results in the tube of the vagina turning inside out. This condition is also known as vaginal “vault” prolapse. Depending upon how extensively the top of the vagina is turning inside out, one or several pelvic organs (such as the bladder, small and large bowel) will prolapse into the protruding bulge. Symptoms depend on which organs are relapsing. When the bladder is involved, women report difficulty in starting to urinate, and emptying their bladder well. If it is the bowel then many report the need to push up the vaginal bulge and strain to have a bowel movement. Skin sores may develop if the bulge is rubbing on pads or underwear. A pessary may provide support for the bulge otherwise surgery is recommended. This is a picture of a vaginal vault prolapse.

Rectal Prolapse
The rectum is the name given to the last 6 inches of the colon. Like the vagina and uterus, the rectum is normally securely attached to the bony pelvis by ligaments and muscles. Infrequently, the supporting structures stretch or detach from the rectal wall which results in the rectum relapsing through the anus. This looks like red, often donut shaped soft tissue coming through the anus. Early on, it is most often noticed on the toilet after a bowel movement, and can be confused with a large hemorrhoid. Conditions associated with straining such as chronic constipation or diarrhea, nerve and muscle weakness (paralysis or multiple sclerosis) and advancing age are risk factors for rectal prolapse. Women with rectal prolapse often report the following symptoms: pain during bowel movements, mucus or blood discharge from the protruding tissue, loss of control of bowel movements, and soft, red tissue protruding from the anus. It is very important to be clear in describing where the bulging tissue is coming from (opening of the anus or the vagina) when you seek help as both conditions may be present simultaneously. Treatment for a rectocele and rectal prolapse are different.

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