Vaginal vault prolapse


Vaginal vault prolapse

Description, Causes and Risk Factors:

Vaginal vault prolapse

Female's vagina is surrounded by a number of sensitive muscles, known as pubococcygeus muscles or pelvic muscles and a network of supportive tissue called fascia, which together act like a composite support structure that holds pelvic organs like uterus, urethra, rectum, bowel and the urinary bladder in their normal positions.

Vaginal vault prolapse occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina. It may occur alone or along with prolapse of the bladder (cystocele), urethra (urethrocele), rectum (rectocele), or small bowel (enterocele). Vaginal vault prolapse is usually caused by weakness of the pelvic and vaginal tissues and muscles. It happens most in women who have had their uterus removed (hysterectomy).

Vaginal vault prolapse can occur due a number of other reasons too:

    Obesity and being overweight.

  • Malfunction of nerves and tissues in the pelvic region.

  • Abnormal functions of the connective tissues.

  • Exhausting physical activities over a fairly long period of time.

  • Genetics and history of any surgery in the pelvic region.

  • Chronic cough.

  • Chronic constipation.

The condition occurs most often in women over the age of 40. It is more common in women who have given birth, women who have experienced menopause, and women who have had a hysterectomy (removal of the uterus).

Symptoms:

Symptoms of vaginal vault prolapse include,

    Pelvic heaviness.

  • Backache.

  • A mass bulging into the vaginal canal or out of the vagina that may make standing and walking difficult.

  • Involuntary release of urine (incontinence).

  • Vaginal bleeding.

Diagnosis:

Generally, the most reliable way that a doctor can make a definite diagnosis of any type of vaginal prolapse involves a medical history and physical examination of the woman. The following are tests that the doctor may use to evaluate women with advanced vaginal prolapse. Since many of these women also have urinary incontinence, these tests can further evaluate the anatomy and function of the pelvic floor.

    Q-tip test: In this diagnostic test, the doctor inserts a small cotton-tipped applicator lubricated with an anesthetic gel into the woman's urethra. The doctor then asks the woman to strain down. If the applicator raises 30 degrees or more as a result, this means that the urethra-bladder neck drops while straining and is a predictive factor of success of anti-incontinence surgery.

  • Bladder function test: This involves a diagnostic procedure called urodynamics. This tests the ability of the bladder to store urine and to dispose of it (urinate). The first step of this test is called uroflowmetry, which involves measuring the amount and force of the urine stream. The second step is called a cystometrogram (CMG). In this step, a catheter is inserted into the bladder. The bladder is then filled with sterile water. The volume at which the patient experiences urgency and fullness are recorded. The pressures of the bladder and urethra are measured and the patient is asked to cough or bear down to elicit leakage with the prolapse pushed up (reduced). This is important clinical information that may assist the surgeon in selecting the correct type of surgery.

  • Pelvic floor strength: During the pelvic examination, the doctor tests the strength of the woman's pelvic floor and of her sphincter muscles. The doctor also assesses the strength of the muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. These findings help the doctor determine if the woman would benefit from exercises to restore the strength of the muscles of the pelvic floor.

The following are imaging test that the doctor may use for further diagnostic purposes, if indicated:

    Magnetic resonance imaging (MRI) scan: This imaging tool uses a powerful magnet to stimulate tissues within the pelvis. These tissues produce a signal, which is analyzed by a computer. A 3D image of the pelvis is then produced on the computer screen using these signals.

  • Ultrasound: This diagnostic tool uses sound waves. Sound waves are reflected back when they contact relatively dense structures, such as fibrous tissue or blood vessel walls. These reflected sound waves are then converted into pictures of the internal structures being studied. With an ultrasound, the doctor may visualize the kidneys or bladder in women with urinary incontinence or the muscles around the anus in women with anal incontinence.

  • Cystourethroscopy: A cystourethroscope, which is a small, tube-like instrument, is lubricated with an anesthetic gel and inserted into the urethra. The end of the cystourethroscope has a light and camera, which produces images on a television screen. With this procedure, the doctor can view inside the urethra and bladder. This procedure is especially valuable for women who have symptoms of urinary urgency, frequency, bladder pain, or blood in the urine. It can be performed in the office using local anesthesia.

Treatment:

The two common types of vaginal prolapse surgery are as follows:

    Vaginofixation: This method is carried out in sexually active women having vaginal prolapse. The surgery involves implantation of an artificial web or mesh in a way so that it connects and supports the vagina and the sacrum or the tailbone holding the vagina in its original position.

  • Plication: This particular type of surgery involves reconnecting the weakened tissues to each other in order to enhance their collective strength to hold back the pelvic organs together.

During surgery, the top of the vagina is attached to the lower abdominal wall, the lower back (lumbar) spine, or the ligaments of the pelvis. Vaginal vault prolapse is usually repaired through the vagina or an abdominal incision and may involve use of either your tissue (autologous) or artificial material (non-autologous or synthetic).

Doing Kegel exercises on the regular basis strengthens your pelvic muscles and can help heal vaginal prolapse at early stages, and if done together with a proper Kegel devices.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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