Collapse of the anterior and posterior walls of the vagina: symptoms, what to do, how to treat

Vaginal prolapse is a pathology that is caused by insufficient muscle strength and pelvic structures, which results in changes in the physiological localization of the organs of the reproductive, urinary and digestive systems.

The prevalence of the pathology is significant, as every third woman after 45 suffers from vaginal prolapse. In addition, up to 80 years old, 10% of women have already undergone surgery for this reason.

The cause of the disease may be excessive physical exertion with lifting weights, injuries sustained during labor, frequent constipation, excess weight and age-related involutional processes in the body.

Depending on which part of the vagina has fallen out - the front, back, or both walls at the same time, the pathology is classified as complete prolapse, after which prolapse of the uterus is observed, and partial - with a change in the localization of any wall with subsequent prolapse of parts of the intestine and bladder.

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Causes of vaginal prolapse

The change in the physiological localization of the vagina is observed due to a change in muscle tone, as a result of which the structures in the small pelvis change their location. Most often, the pathological condition bothers women who have given birth in old age, who have more than 3-4 children.

In addition, the following causes of vaginal prolapse are identified: excessive physical exertion associated with carrying heavy loads, multiple births, difficult labor, which is accompanied by complications in the form of birth injuries.

We should not forget about age-related changes, during which destructive changes occur that affect the state of the pelvic muscular system.

Causes of vaginal prolapse may also include metabolic diseases and endocrine pathology, which results in excess weight. Frequent constipation and respiratory diseases affect the condition of the vaginal and uterine muscles.

Vaginal and uterine prolapse are rarely seen separately, as the vagina is closely connected to the uterus. As soon as the uterine ligaments weaken, the vagina can descend until it is no longer visible from the genital slit.

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Vaginal prolapse after childbirth

Vaginal prolapse after childbirth occurs as a result of the development of functional insufficiency of the ligamentous apparatus, due to which the internal organs of the small pelvis are in their places, and the pelvic muscles.

Prolapse is facilitated by numerous factors that have an impact during pregnancy and labor. Thus, it is necessary to highlight damage to the pelvic floor after trauma received during childbirth.

Vaginal prolapse after childbirth occurs as a result of significant perineal tears that were not stitched properly, or infection of the sutures.

The walls of the pelvic organs are lowered due to muscle stretching or trauma to the perineal tissue. In addition, it is necessary to pay attention to the presence of disorders of the innervation of the sphincter muscles located in the urethra and anus.

The size of the fetus is of particular importance, since if the volume is large and needs to pass through the birth canal, an episiotomy should be performed, as a large fetus contributes to the development of muscle weakness.

Vaginal prolapse after surgery

The vagina is closely connected to the uterus and surrounding muscular structures. A change in the localization of one or two walls threatens complete prolapse of the vagina with surrounding organs.

Vaginal prolapse after surgery may occur in cases where surgical intervention is performed on the pelvic organs. In addition, the operation may involve structures of the female reproductive system.

In order for vaginal prolapse to occur after surgery, the ligamentous apparatus of the uterus and other genitals must be damaged. Incorrect suturing of damaged tissues or weakening of the strength of the pelvic floor muscles or ligaments that hold the uterus at a certain level can provoke prolapse of one of the vaginal walls.

Surgery after trauma (falls from height, ligament ruptures or pelvic bone fractures) can also leave complications in the form of weakened muscles. As a result, vaginal prolapse will gradually occur.

Vaginal prolapse after hysterectomy

The vagina is closely connected with the uterus, however, in some cases, the latter must be removed, and sometimes even with part of the vagina. This concerns oncological pathology and other additional formations that spread to these structures.

Vaginal prolapse after hysterectomy is a fairly common manifestation and is associated with a violation of the anatomical location of the pelvic organs. However, not only the vagina can prolapse, but also the bladder, which is located in front of it.

To prevent such complications after removal of the uterus, it is recommended to perform special exercises that will help to increase the tone of the vaginal muscles and maintain them in their original position.

Physical exercise helps strengthen the muscular structures of the pelvic floor, thereby reducing the risk of changes in the location of the bladder and intestines. You should also monitor your weight and avoid increasing it, especially women who have undergone surgery, use hormonal therapy to provide the body with missing hormones.

Symptoms of vaginal prolapse

At the beginning of the development of the pathology, the symptoms of vaginal prolapse may not bother. As the intensity of the pain syndrome of a pulling nature in the lower abdomen increases, the woman does not attach any importance to this, as she assumes the onset of premenstrual syndrome.

However, it is with this symptom that in a third of all cases the clinical manifestations of vaginal prolapse begin. Later, symptoms of vaginal prolapse are observed, associated with dysfunction of other organs - urinary incontinence, difficulty in urinating, with tension of the abdominal muscles when laughing, coughing, screaming, pain in the lumbar region or intestinal disorders, which are manifested by constipation or diarrhea.

As for the genitals themselves, it is worth highlighting a decrease in sensitivity during sexual intercourse, the appearance of erosions and ulcerative defects of the vaginal mucosa, disruption of the cyclicity of monthly discharge, as well as the sensation of a foreign body in the perineum.

Due to the typical location of the bladder in front of the vagina, symptoms of cystitis are observed when the anterior wall prolapses. Prolapse of the posterior wall is manifested by frequent constipation and an uncomfortable feeling of the presence of an additional formation in the vagina.

Vaginal prolapse grade 1

The percentage of cases of such pathology as vaginal prolapse of the 1st degree is most often observed after the second or third birth, as a result of which the muscle tone of the pelvic floor decreases, and the vaginal muscles themselves become less strong.

Vaginal prolapse of the 1st degree indicates that the uterus has shifted towards the vagina, as a result of which it has lost its physiological position.

Since the uterus is connected to the vagina, then following the uterus, it also begins to change localization. As a result, the walls of the vagina descend to the entrance, and the external uterine os is at a level below the spinal plane.

The first stage is characterized by a gaping of the genital slit, because the pressure of the uterus on the vagina increases, which in turn tends to go outward. Despite this, there is still no protrusion of parts of the vagina or other organs beyond the genital slit.

At this stage, clinical manifestations include minor pain sensations similar to premenstrual syndrome, dysuric disorders as a result of the bladder being involved in the process, and discomfort in the vagina.

Vaginal prolapse grade 2

The absence of treatment of the first stage of pathology manifests itself as vaginal prolapse of the 2nd stage. Thus, this condition is characterized by the approach of the cervix to the genital slit, which indicates greater relaxation of the muscles.

In some cases, the second degree includes a slight protrusion of the vaginal walls outward. In parallel with this, a change in the localization of other structures that are directly connected to it is noted following the vagina.

This concerns the bladder - with prolapse of the anterior wall, and the intestines - with the posterior wall. Symptomatically, prolapse of the vagina of the 2nd degree is manifested by a disruption in the functioning of the affected organs - the appearance of frequent urges to urinate and difficulties with it, constipation or diarrhea, pain in the groin or abdomen and an unpleasant sensation of an additional formation in the vagina and perineal area.

Prolapse of the vaginal walls

A serious pathological change in the physiological localization of organs is the prolapse of the vaginal walls. In this case, the functioning of not only these organs is disrupted, but also those adjacent to them, for example, the bladder and intestines.

Prolapse of the vaginal walls occurs not only in old age, when due to destructive processes the muscles partially lose their tone, but also at the age of 30. The number of cases reaches 10%, however, with age the frequency increases and by the age of 45 it reaches 35-40%.

The process of vaginal prolapse involves weakening of the pelvic floor muscles and increased pressure in the abdominal cavity as a result of chronic constipation or excessive physical labor with heavy lifting.

There are many reasons for the development of pathology, the main ones being injuries received during labor, tumors in the pelvic cavity, excess weight, more than 2 births, and age-related changes.

Prolapse of the anterior vaginal wall

The prolapse of the anterior vaginal wall is observed most often after childbirth, as the muscles become weaker. In addition, there are complications during labor, such as perineal ruptures. As a result, the wound is sutured, but subsequently loses muscle strength.

Prolapse of the anterior vaginal wall is characterized by an increase in pain syndrome of a pulling type, localized both in the lower abdomen and in the lumbar region. As the vagina prolapses, a sensation of the presence of a foreign body appears in the area of the genital slit.

During sexual intercourse, unpleasant sensations, even pain, appear, as a result of which the woman cannot fully relax, which leads to emotional stress. Periodically, bloody discharge is observed, not associated with the menstrual cycle.

The location of the bladder - in front of the vagina, causes a violation of its function. Thus, frequent urges and difficulties with urination are possible. As for the intestines, constipation is observed in a third of all women with a changed localization of the posterior wall of the vagina.

Posterior vaginal wall prolapse

Pathology - prolapse of the posterior vaginal wall occurs as a result of failure of the pelvic muscles of the posterior fornix. An accompanying complication is partial or complete destruction of the endopelvic fascia, which separates the intestine from the posterior vaginal wall.

Posterior vaginal wall prolapse has some clinical features that distinguish it from anterior wall pathology. Insufficiency of the pelvic muscles contributes to the prolapse of the posterior vaginal wall inward due to the pressure of the rectum.

Since there is no fascia between them, part of the intestine fills the back wall, causing it to increase in size (in the form of a bubble). Thus, as the "bubble" grows, a sensation of a foreign body in the vagina appears, which is present during walking or sitting.

In addition, it is worth highlighting the symptom associated with bowel dysfunction. Thus, each process of defecation is accompanied by pain and great efforts to facilitate the movement of feces through the intestines and their exit from the formed pocket.

Vaginal prolapse during pregnancy

Under the influence of constant high pressure on the pelvic muscles as the fetus's body weight increases, vaginal prolapse occurs during pregnancy. This process begins approximately at the 10th-12th week, as a result of which the muscles are under tension.

In addition, their condition before pregnancy should be taken into account. If the muscles were already weakened due to other reasons, then by the end of pregnancy not only the vaginal wall may drop, but also prolapse through the genital slit.

Vaginal prolapse during pregnancy occurs after strong pressure from the uterus, which can also descend under the weight of the fetus. Thus, the muscles lose elasticity and stretch.

The danger of the pathology is due to the impact on the pregnant woman and the fetus, with a high probability of developing spontaneous abortion or premature birth.

In case of 1st degree prolapse, doctors recommend using special exercises that will strengthen the muscles and facilitate the process of childbirth. As for more serious degrees of prolapse, it is necessary to use a bandage, pessary, and the issue of childbirth is decided individually.

What to do if vaginal prolapse occurs?

What to do with vaginal prolapse? At the first stage of the pathology, conservative treatment methods can be used. They include: physical exercises, gynecological massage and medicinal herbs. All these methods are needed to increase the tone of the pelvic muscles and reduce the likelihood of vaginal prolapse.

There is another method of combating vaginal prolapse – a pessary or otherwise – a uterine ring. It is placed in the vagina, which helps to maintain the cervix in a physiological position.

As a result, the uterus is in a slightly elevated position, since the pessary covers the cervix and holds the entire organ. Such a ring is rational to use with minor prolapse or in old age, given that age-related changes contribute to a decrease in the size and weight of organs.

The disadvantage of the pessary is the need for frequent washing, as well as individual selection in volume. In addition, the use of a bandage, which also supports the pelvic organs, is considered mandatory.

Treatment of vaginal prolapse

The treatment tactics are determined by the degree of development of the pathology, the woman's age and the presence of concomitant diseases. It is customary to distinguish two directions in treatment - conservative and surgical.

Conservative treatment of vaginal prolapse is used at the 1st degree of prolapse, when the vaginal structures do not cross the border of the genital slit. It consists of limiting physical activity, lifting weights, conducting a course of gynecological massage, and performing special physical exercises.

Treatment of vaginal prolapse is aimed at strengthening the pelvic muscles, supporting structures and abdominal muscles, thanks to which the internal organs maintain their physiological position. In addition, during the massage and exercise, blood circulation in the pelvis is activated, which is also necessary for treatment.

At stages 2 and higher, surgical intervention is recommended to restore the muscular structures of the pelvic floor. Thus, colporrhaphy or colpoperineorrhaphy is used to lift the organs inside the pelvic cavity.

Vaginal prolapse surgery

The method of treating the pathology - surgery for vaginal prolapse consists of performing colpoplasty, the essence of which is based on suturing the walls of the vagina. This type of surgical intervention is of two types: colporrhaphy and colpoperineorrhaphy.

The first form of surgery involves resection (excision) of the vaginal wall tissues that have "stretched" with subsequent suturing of the remaining structures. In the process of colpoperineorrhaphy, the size of the posterior wall is reduced by suturing it, as well as tightening of the pelvic muscles.

Surgery for vaginal prolapse may involve an additional stage involving surrounding internal organs such as the bladder, urethra, and rectum. To reduce the symptoms of dysfunction of these organs, it is necessary to restore their physiological position.

Plastic surgery can be performed using one's own tissues or implants. Surgical intervention is performed under general or epidural anesthesia. The choice is based on the scope of the proposed operation, its duration and the woman's health condition.

Surgery for prolapse of the anterior vaginal wall

In order to tighten the organs, ensuring their physiological position, and to prevent the formation of new defects that can provoke a relapse, an operation is used for prolapse of the anterior vaginal wall.

In addition, surgical intervention improves a woman's sexual activity and is used to treat urinary incontinence.

The operation for prolapse of the anterior vaginal wall is called anterior colporrhaphy. Modern equipment allows the use of vaginal access, which is less traumatic than laparoscopy and access through the abdominal cavity.

The preparatory period before the operation includes the use of hormonal agents, especially for women in the climacteric period. They are necessary to improve local blood circulation, which has a positive effect on the postoperative recovery period.

After surgery, it is necessary to use antibacterial drugs to prevent infection of the operated area, as well as painkillers, with the exception of aspirin. In addition, it is recommended to abstain from sexual activity for at least a month.

Surgery for prolapse of the posterior vaginal wall

The operation is performed in case of prolapse of the posterior vaginal wall to resect the intestine, which protrudes towards the vagina and puts pressure on its posterior wall, and to restore the rectovaginal septum.

Surgical intervention consists of eliminating the intestinal protrusion, strengthening the wall of the (anterior) rectum, the partition between the intestine and the vagina, and normalizing the function of the anal sphincter.

Surgery for prolapse of the posterior vaginal wall involves suturing the intestinal wall with a group of muscles that lift the anus, which helps strengthen the septum between the organs.

In the presence of concomitant pathology and involvement of surrounding organs in the pathological process, the scope of surgical intervention is increased to eliminate the physiological location of the structures.

Thus, a combination of the main direction of the operation with the treatment of prolapse of the anterior vaginal wall, hemorrhoids, polypous formations or anal fissure is possible. As a result, the time of surgical intervention increases. In addition, in some cases, endoscopic treatment with the installation of a mesh implant is allowed.

Exercises for vaginal prolapse

The close connection of the vagina with the uterus predisposes them to prolapse together, first the vagina and then the uterus. Exercises for vaginal prolapse have a strengthening effect on the muscles with which the organs maintain their physiological position.

The maximum result can be achieved by using these exercises at the initial stage of vaginal prolapse, since other structures are not yet involved in the pathological process.

The simplest exercise for training is to stop urinating by squeezing the muscles. If you stop the stream periodically during urination, this will help strengthen the muscles and overcome urinary incontinence.

Exercises for vaginal prolapse should be performed at different speeds throughout the day. Of course, you shouldn't exercise constantly, but 3-4 times a day, several exercises, will help to normalize muscle tone soon.

The training can be done while sitting at a computer, standing at a bus stop, or at home in the “lying down” and “on all fours” positions.

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Kegel exercises for vaginal prolapse

Before you start doing the exercises, you need to determine which muscles you will have to work with and where they are. To do this, try to stop the stream while urinating and remember how to do it. These muscles will need to be trained in the future.

Kegel exercises for vaginal prolapse include 3 types of execution. First, it is the compression of those same muscles. However, the execution should be slow, having compressed the muscles, you need to count to 3 and slowly relax them.

After this, you need to do the same thing, only quickly. And finally, the "pushing out" is done by tensing the abdominal muscles, as during childbirth, but much weaker.

In order to control the correctness of the exercises, it is recommended to insert a finger into the vagina and monitor the contractions.

At first, you need to start with 10 repetitions of each exercise, performing 5 times a day, and then gradually increase the load. After a week, you should add 5 repetitions to each exercise and so on until you get 30 times. To maintain the effect, you can stop at this load and perform these 3 exercises 30 times 5 times a day.

Bandage for vaginal prolapse

Prolapse of organs occurs due to the loss of the muscular framework that supports them. Thus, after pregnancy and childbirth, muscle relaxation is most often observed to such an extent that vaginal prolapse is possible.

A bandage for vaginal prolapse is necessary to maintain constant intra-abdominal pressure without lifting, which affects the position of the uterus and vagina. The bandage gives the muscles time to restore their tone and strengthen the organs in physiological positions.

Despite its effectiveness, a bandage for vaginal prolapse should not be used constantly, as the organs need rest. Thus, it is not rational to use it at night, as neither gravity nor pressure contribute to vaginal prolapse.

During even minor physical activity (walking, doing housework), it is necessary to wear a bandage to support the organs. In addition, it is mandatory after operations on the uterus and vagina, since the muscles in the postoperative period are the weakest and are not able to perform the main function.

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Folk remedies for vaginal prolapse

In order to treat the pathological condition, it is recommended to use physical exercises and folk remedies for vaginal prolapse at the same time. For this, a collection of herbs is used, taken internally, in the form of baths or douching.

For the decoction, you need to take lemon balm and linden flowers - a quarter of a glass each, white deadnettle - 70 g and alder root - 1 dessert spoon. After thorough grinding, you need to select 30 g of the mixture and pour boiling water in the volume of one glass.

The decoction should be infused for about 1 hour, after which it should be filtered and taken 100 ml three times a day half an hour before meals. The course lasts 20 days, and then a break is needed - half a month.

For douching, you will need to prepare a solution from quince, which must be crushed and filled with water, the volume of which is 10 times greater than the quince. After boiling for 25 minutes, filter the broth and cool to a warm comfortable temperature. Douching with this solution helps to increase muscle tone.

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Exercise therapy for vaginal prolapse

The exercises should be repeated every morning before meals, starting with the minimum load and gradually increasing it. Physical therapy for vaginal prolapse helps restore the previous muscle tone and strengthen them significantly longer.

"Bicycle" is an exercise that everyone has long been familiar with. To do it, it is enough to pedal an imaginary bicycle while lying down for about a minute, raising your legs at 45°. "Scissors" are performed in the same way, but with straight legs.

Lie down on the floor, place a rolled-up roller under your buttocks, while your back remains on the floor. Raise your left leg straight up to 90°, then lower it and change to the other. Repeat 8-12 times.

The exercise is more difficult if you remove the roller and lift both legs at the same time to the angle perpendicular to the floor. Standing next to a chair, you need to hold on to it and move your leg to the side to perform circular movements for 30 seconds. Then change the direction, and then the leg. Also, while standing, you need to swing your legs up to 7 times each, stand in the "swallow" pose for about a minute.

Vaginal prolapse can bother women at any age, but there is an effective way to prevent muscle weakening - physical exercise, so if you really want to, you can independently reduce the chances of developing pathology.

Sex with vaginal prolapse

The pathology must be considered individually in each case, taking into account the degree of prolapse and the woman's sensations during intercourse. Sex with vaginal prolapse is allowed at the initial stage, but it should be taken into account that excessive passion can aggravate the situation and cause pain to the woman.

Starting from the 2nd stage, not only the vagina but also the uterus is involved in the process, so their localization changes, as a result of which the woman herself is unlikely to experience pleasure during sex.

Sexual intercourse helps to strengthen muscles, but only at the stage of normal physiological arrangement of organs. In the case when a woman begins to experience pain during sexual intercourse, this is a signal to stop and consult a doctor.

In addition to physical pathology, a woman may develop a depressive state, since pleasure in sex is not delivered, and it is also possible to visually examine parts of the vagina outside the genital slit.