Vaginal vault prolapse at a glance
- Vaginal vault prolapse occurs when the upper portion of the vagina drops into the vaginal canal.
- Vaginal vault prolapse is usually caused by a weakening of the supporting pelvic tissues and muscles at the top of the vagina, which then loses its normal shape and sags downward.
- Symptoms of vaginal vault prolapse include backache, tissue mass bulging into or from the vagina canal, urinary incontinence and pain during intercourse.
- Surgery is the primary treatment and involves repairing the supporting structures of the upper vagina.
What causes vaginal vault prolapse?
Vaginal vault prolapse is one of several types of pelvic organ prolapse (POP) in which an organ drops (prolapses) into the vaginal wall. In the case of vaginal vault prolapse, the upper part of the vagina is the organ that prolapses. Other forms of pelvic organ prolapse (such as bladder, rectum, small bowel) are very often present when a vaginal vault prolapse occurs.
Vaginal vault prolapse most often occurs in women who have had a hysterectomy, which is the removal of the uterus. The uterus helps support the upper vagina. As the upper vagina falls into the vagina canal, the vaginal walls may also weaken. The general effect is that the vagina turns inside out, and eventually the top can protrude from the vagina opening.
Vaginal childbirth is the number one risk factor for vaginal vault prolapse. Other contributing factors include previous surgery for other forms of pelvic organ prolapse, genetic weakness in supporting tissue, lifestyle factors – such as obesity – that increase pressure on the vaginal supporting structures, and chronic conditions that create stress, such as constipation and violent coughing.
Symptoms of vaginal vault prolapse
Symptoms of vaginal vault prolapse can be distressing and affect a woman’s lifestyle. These symptoms include:
- The feeling of pressure in the vagina or of a mass falling into the vaginal canal
- Weak urinary stream, straining to urinate and difficulty emptying the bladder
- Increased urinary infections
- Vaginal bleeding and discharge
- A bulge of tissue that may protrude from the vagina, and the need to apply finger pressure to this bulge in order to urinate or empty the bowels
- Pain during sexual intercourse
Treatments for uterine prolapse
Surgery is the primary treatment for vaginal vault prolapse, although pelvic floor exercises and pessary rings can be helpful to women for whom surgery is not an option. Surgery involves methods to rebuild the supporting structures of the upper vagina and to mediate symptoms. Surgical options depend on the individual’s particular vaginal vault prolapse, her history and overall health.
Tissue grafts or synthetic meshes can be used to repair the supporting structures of the upper vagina in vaginal vault prolapse. The manner and placement of the restructuring vary according to the patient. These are typically performed by a urogynecology specialist.
In some cases, minimally invasive surgery may be performed. A hysterectomy (if not already performed) may also be part of treatment for vaginal vault prolapse.