DEAR MAYO CLINIC: What is the best long-term treatment for vaginal prolapse? I am in my late 50s.
ANSWER: There are nonsurgical and surgical treatment options for vaginal prolapse, and the treatment that is best usually depends on the severity of the condition and how much the symptoms are bothering you. Surgery often is recommended to repair the vagina’s support for women who are having persistent symptoms as a result of vaginal prolapse.
Vaginal prolapse, also called pelvic organ prolapse, occurs when the muscles, connective tissue and ligaments that support the vagina weaken and stretch, causing the tissue to drop down, or prolapse, into the lower portion of the vagina or out the vaginal opening. This may lead to a feeling of pelvic pressure or fullness, or a feeling of a bulge from the vagina. For some women, these symptoms may be mild in the morning but worsen throughout the day.
A number of factors can lead to vaginal prolapse, including pregnancy, vaginal childbirth, chronic cough, and aging. Chronic constipation, loss of muscle tone, lack of estrogen in the body after menopause, and repeated straining or heavy lifting over time also may contribute to weakening of the vaginal muscles and supportive tissues.
If vaginal prolapse does not cause symptoms, or if you can manage your symptoms and they do not disrupt your daily activities, you may not need immediate treatment. Over time, however, the muscles and ligaments supporting your vagina may continue to weaken, so without treatment the prolapse could get worse. Because of that, it is important to follow up with your healthcare provider as time goes on to monitor your symptoms and the severity of the prolapse.
If vaginal prolapse makes it difficult for you to have a bowel movement, results in urinary problems, causes pain, leads to sexual problems, or causes other ongoing symptoms, then treatment usually is necessary. For mild to moderate cases, self-care measures, such as performing exercises called Kegels to strengthen your pelvic muscles, may reduce your symptoms.
There are things that you can do to provide symptom relief. Maintaining a healthy weight, avoiding heavy lifting and straining, and taking steps to ease constipation can reduce pressure on the muscles and tissue that support your vagina. Nonsurgical therapy in the form of a pessary — a small device inserted into the vagina to prevent the tissue from prolapsing — is also an option to consider.
For more severe cases of vaginal prolapse or when other measures do not help, surgery can be a useful treatment option. Surgery involves repairing the damaged or weakened tissue, as well as reconstructing the vaginal support, so the vagina will stay in place.
Until recently, some surgeons used transvaginal mesh inserted into the vaginal tissue to provide support. But in 2019, the Food and Drug Administration ordered manufacturers of surgical mesh for the transvaginal repair of pelvic organ prolapse to stop selling and distributing their products in the U.S. These products were associated with complications such as pelvic pain and discomfort during sexual intercourse. The mesh also may eventually protrude through vaginal tissue.
Women who have had transvaginal mesh placed for the surgical repair of pelvic organ prolapse should talk to their healthcare provider if they have complications or symptoms.
Mayo Clinic surgeons often use a woman’s own tissue to repair torn or damaged areas associated with vaginal prolapse. The specific surgical approach used depends on your needs and circumstances.
As you consider surgery, be sure to ask questions. The various surgical approaches have different risks and benefits. Talk about them with your surgeon, along with possible long-term side effects and complications. In some cases, vaginal prolapse can recur, even after surgery. Ask your surgeon about this possibility and if there are ways to reduce your risk of recurrence.
Take time to understand all your treatment options before you proceed so that you can make a well-informed choice that fits your needs. — John Gebhart, MD, Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota