The vagina is a structure of the female body that can adapt very well to different requirements. For example, the vagina stretches considerably when a child is born. It then returns to its original width.
Vaginal descent (descensus vaginae) occurs when the vagina can no longer be held in position. This is caused by damage to the supporting structures of connective tissue and the pelvic floor muscles. Possible effects affect bladder function and bowel movements. Pain can also be the result.
Due to the upright gait, the birth canal is located in the pelvis with its opening at the bottom. The bony pelvis is closed by the pelvic floor muscles (mainly the levator group) and by connective tissue support structures (ligaments and fasciae). The vagina remains as an opening. This is massively stretched during the birth process to allow the baby to pass through. Damage to the supporting structures and muscles can already occur during the birthing process. Tearing of the muscles and connective tissue and overstretching of nerves are possible.
Pressure from the organs in the abdominal cavity and chronic strain over many years put a lot of strain on the pelvic floor. With a corresponding predisposition, it becomes damaged. The result is a vaginal prolapse and/or a prolapse of the uterus. As the urethra and bladder lie directly against the front wall of the vagina, they also descend. The rectum is held in position by the back wall of the vagina. If this gives way, this part of the bowel also descends. Obesity and smoking are other factors that contribute to vaginal prolapse.
Vaginal prolapse can cause a variety of functional disorders due to the associated change in the position of the neighboring organs:
In the case of pronounced prolapse, the anterior and posterior vagina or the uterus prolapse in front of the vaginal entrance. If a descensus vaginae persists for a longer period of time, ulcerations (open sores) develop, which can also bleed a little.
You can prevent vaginal prolapse by taking the following measures:
Unfortunately, congenital connective tissue weakness cannot be improved. After the menopause, low doses of estriol in the vagina can have a positive effect on the tissue.
The gynecologist is usually the first point of contact. They can already detect vaginal prolapse during a routine check-up. Patients with bladder dysfunction often also consult a urologist.
Conservative treatment, i.e. initially no surgery, is often initiated in the practice. If the vaginal prolapse or dysfunction is severe, surgery may be necessary. You should then visit a urogynaecology clinic or a pelvic floor center.
A harmless ultrasound examination can be used to assess the change in position of the urethra, bladder, vagina, uterus and bowel more accurately. Sometimes a urodynamic examination is also necessary. This can be used to assess the storage function of the bladder and incontinence. In complex cases, an X-ray examination of the bowel or bladder or an MRI of the pelvis is also used.
With physiotherapeutically supervised pelvic floor training, which also includes back and abdominal muscles, it is sometimes possible to stabilize vaginal prolapse. This is especially true if there is no prolapse. In addition, oestrogen is administered into the vagina if possible.
Pessaries (rings, cubes or shells made of silicone) can be used to reposition the descensus vaginae and stabilize the position of the vagina. These are used in cases where surgery is not yet necessary or desired. The aim is for the woman to change them regularly. Pessaries can also be used if an operation appears too risky for medical reasons.
In the case of pronounced prolapse, the quality of life is severely impaired by the dysfunction of the bladder and bowel. Surgery can restore the original position of the vagina with the bladder and bowel.
There are several surgical procedures for plastic reconstruction of the pelvic floor. The operation is often performed from the vagina (vaginal plastic surgery). The vaginal prolapse is corrected by tightening the connective tissue and using the existing ligament structures. In some cases, a procedure through a small abdominal incision or laparoscopy (laparoscopy) is preferred.
In the past, vaginal prolapse surgery always included removal of the uterus. Today, this can be left in place in many cases. If the connective tissue is weak or the vaginal prolapse recurs after surgery, it is possible to reinforce the tissue with a synthetic mesh. This leads to better stability.
The exact surgical procedure is chosen depending on the individual findings of the vaginal prolapse and the functional disorder. In this way, the doctor aims to achieve the most stable result possible and a good restoration of bladder and bowel function. There are clinics that specialize in the diagnosis and treatment of pelvic floor dysfunction and reconstructive surgery.
Surgery to treat a descensus vaginae can only reconstruct the position of the organs. However, the function of the muscles in the pelvis, bladder and bowel requires ongoing attention. These measures are important for lasting success:
As it is not possible to change the basic weakness of the supporting tissue, vaginal prolapse may occur again later.
The pelvic floor is a weak point in the female body. Exercising the pelvic floor muscles after childbirth can at least delay the onset of vaginal prolapse. If symptoms occur, the gynecologist is the first point of contact. If an operation is unavoidable, it is advisable to consult a clinic specializing in urogynaecology. Today, various surgical methods are available for the treatment of vaginal prolapse, which are applied individually depending on the findings and symptoms.
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