Understanding Vaginal Wall Prolapse: Causes, Symptoms, and Treatment

Vaginal wall prolapse is a condition that can feel a little daunting to discuss, but it’s actually very common, especially among women who have given birth, gone through menopause, or have had certain medical conditions. The good news? It’s manageable and treatable, and by understanding it better, you can make informed choices about your health.

Let’s break it all down so you can feel confident about what’s going on and what you can do about it.

Table of Contents

What is Vaginal Wall Prolapse?

The vagina is supported by a network of muscles and tissues that hold everything in place. However, if these supportive structures weaken or become stretched, the walls of the vagina can start to sag or bulge downwards. This is known as vaginal wall prolapse.

Depending on which part of the vaginal wall is affected, there are different types of prolapse:

Anterior Vaginal Wall Prolapse (Cystocele) – This happens when front wall of the vagina bulges down and the bladder can be affected.
Posterior Vaginal Wall Prolapse (Rectocele) – This occurs when the back wall of the vagina bulges down and the rectum can be affected.
Uterine Prolapse – This happens when the uterus itself descends into the vagina.
Vaginal Vault Prolapse – More common after a hysterectomy, this happens when the top of the vagina loses support and starts bulge downwards.

What Causes Vaginal Wall Prolapse?

There are several reasons why the vaginal walls may weaken over time:

Childbirth: Pregnancy and vaginal delivery can stretch and weaken the pelvic floor muscles, making prolapse more likely. Forceps delivery, episiotomy cuts and childbirth related vaginal/anal tears also play a significant role.
Ageing & Menopause: As women get older, their bodies produce less oestrogen, a hormone that helps keep tissues strong and elastic.
Chronic Straining: Conditions like constipation, chronic coughing, or heavy lifting can put extra pressure on the pelvic organs.
Obesity: Carrying extra weight puts additional strain on the pelvic muscles.
Genetics: Some women are naturally more prone to tissue weakness and may experience prolapse even if they haven’t had children.
Previous Surgeries: Hysterectomy or other pelvic surgeries can sometimes weaken the vaginal wall.

What Are the Symptoms?

The symptoms of vaginal wall prolapse can vary depending on the severity. Some women experience mild discomfort, while others may notice more significant changes. Common symptoms include:

A sensation of heaviness or pressure in the pelvic area.
Feeling like something is “falling out” or bulging from the vagina.
Difficulty emptying the bladder or bowels completely.
Frequent urinary tract infections or needing to urinate more often.
Discomfort or pain during sex.
Lower back pain.
Vaginal dryness or irritation.
Unable to keep a tampon in.

It’s important to note that not everyone with prolapse has symptoms. Some women only discover they have it during a routine check-up for something else. It can be a shock and a worry if it’s commented on and you had no idea!

When Should You See a Doctor?

If you’re experiencing any of the symptoms mentioned, or if you feel a noticeable bulge in your vagina, it’s worth speaking to your doctor specialising in women’s health. Prolapse isn’t life-threatening, but it can impact your quality of life. The earlier it’s identified, the quicker help can be made available to you.

How is Vaginal Wall Prolapse Diagnosed?

You will usually have a diagnosis of vaginal wall prolapse through a pelvic examination. You might be asked to cough or bear down during the exam to see how much the prolapse moves. Sometimes, additional tests like an ultrasound or MRI may be needed to get a clearer picture of what’s going on.

Treatment Options

There are several ways to treat vaginal wall prolapse, and the best approach depends on the severity of the prolapse and your personal circumstances.

Lifestyle Changes

For mild prolapse, simple lifestyle changes can make a big difference:

Pelvic Floor Exercises (Kegels): Strengthening the muscles of the pelvic floor can help support the vagina and prevent worsening prolapse.
Managing Constipation: Eating a high-fibre diet and drinking plenty of water can help reduce straining during bowel movements.
Weight Management: Maintaining a healthy weight reduces pressure on the pelvic organs.
Avoid Heavy Lifting: If lifting is necessary, using proper techniques can help reduce strain.

Vaginal Pessaries

A vaginal pessary is a small, silicone device inserted into the vagina to support the prolapsed walls. Pessaries come in different shapes and sizes, and a doctor can help find the right fit for you. They are a great option for women who want to avoid or delay surgery.

Hormone Therapy

For peri/postmenopausal women and those with premature ovarian insufficiency, oestrogen therapy (usually in the form of vaginal creams or rings) can help strengthen the vaginal walls and improve symptoms.

Surgery

If the prolapse is severe or causing significant discomfort, surgery may be recommended. There are different surgical options, including:

Vaginal Repair Surgery: This tightens the weakened vaginal walls and restores support.
Hysterectomy: If the uterus is involved, removing it may be an option.
Mesh Repairs: In some cases, surgical mesh is used to provide additional support, though this has become less common due to safety concerns.

Surgery is generally successful, but it’s not always permanent—prolapse can return, especially if the underlying causes (like heavy lifting or chronic coughing) aren’t addressed.

Can You Prevent Vaginal Wall Prolapse?

While there’s no guaranteed way to prevent prolapse entirely, there are plenty of things you can do to lower your risk:

Stay Active: Regular exercise helps keep muscles strong.
Practice Good Posture: Poor posture can add strain to your pelvic area.
Do Pelvic Floor Exercises: These can be done anywhere and at any time! Make sure you’re targeting the right muuscles by using vaginal devices that give feedback when you’re working the right muscles.
Avoid Smoking: Smoking can lead to chronic coughing, which increases pelvic pressure.
Take Care Of Yourself After Childbirth: Pelvic floor physiotherapy after childbirth can help restore muscle strength.

Final Thoughts

Vaginal wall prolapse might feel embarrasing to bring up, but it’s a common and treatable condition so please get help. The key is awareness—knowing what symptoms to look out for and what steps to take. Whether it’s through lifestyle changes, pessaries, or surgery, there are solutions to help you feel comfortable and confident again. If you’re ever in doubt, don’t hesitate to chat with your doctor or book in with us. Your pelvic health is important, and there’s no need to suffer in silence!

Until next time,

Dr Nikki