Vaginal wall prolapse can be descent of bladder (cystocele), womb, top of the vagina (vault prolapse) or bowel (enterocele/rectocele) from its normal position. It is due to weakness of tissues that support pelvic organs. Childbirth can cause some weakness of pelvic floor, which can get aggravated by chronic straining i.e. chronic cough, constipation etc. and due to lack of estrogen after menopause.
It usually present as symptoms of vaginal bulge or dragging sensation, urinary/bowel symptoms and sexual discomfort.
Vaginal wall prolapse can be managed by physiotherapy (pelvic floor exercises or biofeedback using vaginal cones), use of vaginal pessaries or by surgical treatment. The surgical treatment involves supporting defect using native tissue support by different surgical techniques or by ligament support (sacrospinous fixation) and sometimes by use of mesh (vaginal mesh repair or sacrocolpopexy). One does not always need removal of uterus to treat prolapse.
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