Here is Why It Feels Like Your Vagina Is Falling Out?
Having a baby is a miracle for some women, but pregnancy can leave your body out of shape longer than when you were pregnant. Weight gain, stretch marks and pelvic organ prolapse will not resolve with at a predicted set time. You lose some of the weight but you still have stretch marks.
The baby that you delivered 40 years ago is now an adult and now you have symptoms of what might be pelvic organ prolapse. This is because a combination of the natural process that occurs with aging, menopause and weak pelvic floor muscles results in a herniated pelvic floor.
According to the The Cleveland Clinic, pelvic organ prolapse such as uterine and vaginal prolapse affects about 30% 0f women in the United States. The women that are mostly affected by this condition are women that had multiple vaginal delivery and postmenopausal women.
The medical name for the womb is a uterus. One of the main characteristics that distinguish female from male is the presence of a uterus. Women have one but men don’t. They can give men vaginas and breast but as of now, not uteruses or any other female reproductive organ.
Your uterus stores and protect the ovum that will later become a fetus that develops into a baby. Therefore, if you do not have uterus you cannot have a baby.
The entry point to your uterus is through the vagina. On imaging studies, it can be seen in the pelvic area (between the 2 to hip bones) between the bladder and rectum. Therefore, conditions that affects the bladder and rectum can also affect the uterus.
In addition, if you have problem with your uterus, your physician can evaluate your uterus by performing a vaginal exam/pelvic exam. For example, fibroids can be seen via vaginal exam.
Uterine prolapse is a condition where the pelvic floor muscles, ligaments and other supporting structures becomes too weak to support the uterus. Because of this, the uterus slides down and protrude through the vagina. This process occurs gradually over several years.
Uterine prolapse can happen to women of all ages. Generally, however, it affects women who are in the postmenopausal stage and those who’ve experienced one or several vaginal deliveries.
Since all pelvic organ prolapses are group together, the exact number of women affected by uterine prolapse is unknown. According to results published by the Women’s Health Initiative (WHI) 14% of 27,342 women that participated had some degree of uterine prolapse (Doshani, et al.).
Signs and Symptoms of Uterine Prolapse
Mild cases of uterine prolapse don’t produce significant or noticeable signs and symptoms. In severe cases, the bulging can be felt or seen in the vagina or even outside. However, as the condition worsens, the following may happen:
- Feeling of a bulge, pressure inside the vagina
- Visible bulge inside or outside the vagina
- Leaking of urine
- Frequent urination (without increase fluid intake)
- Feeling of the constant need to urinate
- Weak urine (dribble)
- Long urine stream ( without increase fluid intake)
- Feeling like still need to urinate even after urinating
- Can only urinate in certain position
- Leaking of stool
- Feeling of incomplete emptying
- Difficulty having bowel movement
- Can only urinate in certain position
- Pain with sexual intercourse
- Lack of sensation during intercourse
Stages of Uterine Prolapse
Uterine prolapse is typically determined based on how far it has descended into the vagina.
- Stage I– At this stage, the uterus has prolapsed in the upper half of the vagina.
- Stage II– The uterus has dropped near the vaginal opening.
- Stage III– The uterus has protruded out of the vagina.
- Stage IV– The uterus completely protrudes out of the vagina.
What Causes Uterine Prolapse?
Uterine prolapse generally happens when the muscles of the pelvic floor become weak due to excessive prolonged pressure . Some of the most common causes include:
- Lifting heavy objects frequently
- Severe and chronic coughing
- Trauma during delivery
- Vaginal Delivery
- Giving birth to a large baby
- Multiple Pregnancy
- Menopause where estrogen levels drop
- Straining during bowel movements
- Past pelvic surgery
- Genetic factors that cause weakened connective tissue
- Family History
Diagnosing Uterine Prolapse
Before a diagnosis is made, doctors will ask about any symptoms and perform a physical examination, focusing on the pelvic region. During the assessment, vaginal tone and organ placement will be evaluated.
To assess the severity of prolapse, an MRI or ultrasound will be required. These are imaging studies that can visually show the status of the organ, enabling doctors to confirm the diagnosis.
Treatment for Uterine Prolapse
If the case is mild, such as stage I and stage II, strengthening the pelvic floor muscles is often enough to minimize the symptoms of the prolapse. Pelvic floor exercises, such as Kegel exercise, offer a way to boost pelvic support and strength.
For the exercises to be effective, it is important to seek the help of a pelvic floor physiotherapist, particularly if a prolapse exist. This will help ensure that the exercise is done safely and properly.
These exercises are easy to perform, whether standing, lying down or sitting. It needs to be done around 5 to 6 times a day while one is still familiarizing with the exercises. However, if the patient already has a good understanding, three sessions should be enough for a day.
Biofeedback may also be applied. During a biofeedback treatment, a device will be used to monitor muscle contraction as well as the strength of the pelvic floor muscles. It will also show the timing of Kegels, allowing the therapist to correct or reinforce proper techniques in doing the exercise.
For more severe cases, a vaginal pessary may be helpful. It’s a flexible device that’s fitted into the vagina to provide support to the uterus. It props the organ up and prevents it from sagging and dropping into the vagina.
A pessary comes in different shapes and sizes. The ring type, for example, is used to manage mild uterine prolapse. The donut type, on the other hand, is recommended for moderate uterine prolapse. With that, pessaries are typically fitted and prescribed by a properly trained health professional.
Similar to a tampon, you will be taught how to remove and re-insert the device. This is important as a pessary needs to be washed periodically. The ease of insertion and removal will depend on the type of pessary.
While helpful in managing prolapse, there are a few conditions that aren’t recommended for vaginal pessary insertion. This includes:
- Active infections of the vagina or pelvis
In managing moderate to severe cases, surgical repair may be necessary. It can be done using a laparoscopic/abdominal or vaginal approach. A doctor may decide which approach to take based on age, medical history, ability to have sex, the severity of symptoms, and plans to get pregnant in the future.
In the first option, skin grafting is involved. It may include the use of donor tissue or a separate material to create uterine suspension.
Vaginal surgery, on the other hand, is preferred if there’s a history of complex abdominal surgeries. It’s also the ideal approach if incisions in the abdomen need to be avoided or if there are plans to conceive.
While surgery is generally effective, there are cases where prolapse recur. This particularly happens when the original cause of the condition isn’t corrected.
Uterine prolapse can be prevented. Below are some of the steps that can stop it or minimize its chances of happening:
- Avoid smoking as this will lower the risk of chronic and severe cough.
- Proper diet and exercise are recommended to maintain normal and healthy body weight.
- Estrogen supplements can be taken after menopause as the hormone can help in keeping strong pelvic muscles and ligaments.
- Limit lifting heavy objects. If that’s unavoidable, the use of proper body mechanics when lifting should be observed.
- Avoid straining too much during bowel movements.
- After giving birth, women are advised to perform post-partum pelvic floor exercises.
- For chronic constipation, eating lots of vegetables and fruits can help. Drinking plenty of water can also help. For constipation that results from medical illnesses and condition, doctors may prescribe drugs to make bowel movements easier and more regular.
Uterine prolapse is a condition that is both treatable and preventable. It helps to be aware of its causes, signs and symptoms so that proper treatment can be performed early. The quicker the appropriate treatment is rendered, the lesser the chances of complications occurring..
Downing, Keith T. “Uterine Prolapse: From Antiquity to Today.” Obstetrics and Gynecology International 2012 (2012): 649459-649459. 2 6 2019. .
Ng, Ying Woo, Ambika Paramasivan and Abdul Kareem Saleem Ahmed. “UTERINE PROLAPSE IN PREGNANCY: A CASE REPORT AND REVIEW OF LITERATURE.” The Internet Journal of gynecology and obstetrics 13.2 (2009). 2 6 2019. .
(MedlinePlus Medical Encyclopedia: Uterine prolapse)
Doshani, Anjum et al.. “Uterine prolapse.” BMJ (Clinical research ed.) vol. 335,7624 (2007): 819-23. doi:10.1136/bmj.39356.604074.BE