Have you noticed a feeling of heaviness or pressure “down there,” a bulge in the vagina, or perhaps things just don’t feel as supported as they once did? You’re definitely not alone — and this is not something you need to merely accept. We often have patients asking, “Why is this happening?”, “Is this normal after childbirth or menopause?”, and “What can I do about it?” This post explains what vaginal prolapse is, why it happens, how we evaluate it, and the treatment options that can help you reclaim comfort and strength.
What Is Vaginal Prolapse?
Vaginal or pelvic-organ prolapse occurs when one or more pelvic organs — such as the bladder, uterus, or rectum — descend from their usual position and press into the vagina. The pelvic floor, made up of muscles, ligaments, and connective tissue, normally provides support. When that support weakens or becomes overstretched, these organs can shift downward. Think of this like a hernia in the pelvic floor.
Common types include:
- Cystocele — bladder bulging into the front wall of the vagina
- Uterine prolapse — uterus descending into the vaginal canal
- Rectocele — rectum bulging into the back wall of the vagina
- Vaginal vault prolapse — descent of the vaginal apex, often after hysterectomy
Why Does It Happen?
There are several common contributing factors including:
- Childbirth and obstetric strain
- Hormonal changes/menopause
- Chronic downward pressure (coughing, constipation, heavy lifting, obesity)
- Genetic or connective-tissue predisposition
- Prior pelvic surgery, such as a hysterectomy
How We Evaluate Vaginal Prolapse
Our evaluation typically includes:
- A detailed history and symptom review
- Pelvic exam to assess degree of prolapse and pelvic floor strength
- Bladder and bowel function assessment
- Advanced testing (urodynamics or imaging) in selected cases
Treatment & Prevention Options
The good news is that prolapse is highly treatable. Options range from conservative treatments to surgical repair.
Non-Surgical / Conservative Approaches
- Pelvic-floor physical therapy
- Vaginal pessaries
- Lifestyle modifications (avoiding straining, managing constipation, addressing chronic cough)
- Topical vaginal estrogen for postmenopausal tissue support
- Behavior adjustments that minimize pelvic pressure
Surgical Options
Surgery may be recommended when prolapse significantly impacts daily life or conservative options are not sufficient. Approaches depend on your anatomy, symptoms, and goals.
Vaginal Repair (Native Tissue Repair With or Without Biologic Grafts)
Vaginal repairs use your own tissues — sometimes supported with a biologic graft — to restore support to the vaginal walls. This approach avoids synthetic mesh and is a good option for women with anterior or posterior wall prolapse or those who prefer a vaginal route of repair.
Abdominal Repair with Robotic Sacrocolpopexy
Robotic sacrocolpopexy is a minimally invasive abdominal repair using small incisions and robotic assistance to lift and suspend the vagina to a strong ligament on the front of the sacrum. It provides one of the most durable and long-lasting repairs for vaginal vault prolapse and is especially helpful when the top of the vagina or uterus requires significant support.
When to See a Specialist
You should make an appointment if you experience:
- A visible or palpable bulge
- Difficulty emptying the bladder or rectum
- Pain or discomfort with sex
- New urinary urgency, leakage, or frequency
- A sense that “things are lower” or different than before
Take-Home Message
Vaginal prolapse is not “a normal part of aging” or something you just have to accept. It is treatable with both conservative and surgical options. Whether symptoms are mild or more advanced, there is a pathway toward feeling stronger, supported, and comfortable again.
Schedule an appointment today at the Urology Austin location nearest you.
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