Causes

increased intra-abdominal pressure: pregnancy, obesity, chronic coughing, chronic constipation, intense or improperly guided physical exercise
trauma: vaginal delivery (natural or forceps-assisted), perineal injury, or even previous surgeries such as hysterectomy
collagen deficiency: genetic, smoking, menopause

Symptoms

A feeling of heaviness or a “ball” in the vagina. It may be accompanied by urinary symptoms such as frequent urge to urinate, urinary incontinence (stress or urgency), or difficulty urinating.

There may also be intestinal symptoms such as tenesmus (urgent need to defecate), difficulty with bowel movements, or fecal incontinence. It may also be associated with difficulty having sexual intercourse or a sensation of a “wide vagina.”

Diagnosis

The patient’s history may suggest the condition, but confirmation is through a specialized physical exam, especially using the POP-Q method (Pelvic Organ Prolapse Quantification). Sometimes additional tests are needed, such as transperineal ultrasound or MRI.

Treatment

lifestyle changes: weight loss through a balanced diet and properly guided physical activity.
clinical treatment for genital prolapse: pelvic floor physical therapy, treatment of genital hypotrophy (topical estrogen and/or laser therapy), use of a pessary (a device inserted into the vagina that can be managed by the patient).
surgical treatment for genital prolapse: site-specific surgeries (correction of diagnosed pelvic defects such as fascia reconstruction to “lift” the bladder and intestines, reconstruction of uterosacral ligaments to support the uterus, or even hysterectomy with ligament shortening and perineal reconstruction) or mesh surgeries (using mesh instead of ligaments and fascia to “lift” the pelvic organs).

Prevention

Weight control, properly guided physical exercise, or pelvic floor physical therapy.

By Einstein Editorial Board