• Tuesday Q and A: Surgical and nonsurgical treatment options for vaginal prolapse

DEAR MAYO CLINIC: I have been diagnosed with vaginal prolapse and am not sure where to begin with treatment. What is the best long-term treatment? I am only 53.illustration of vaginal prolapse

ANSWER: Surgical and nonsurgical treatment options are available for vaginal prolapse. The treatment you choose usually depends on the severity of the condition, as well as how much the symptoms bother you. For long-term relief of vaginal prolapse that is causing persistent symptoms, surgery is often recommended to repair the vagina’s support.

Vaginal prolapse happens when the muscles, connective tissue and ligaments that support the vagina weaken and stretch, causing the tissue to drop down, or prolapse, into the lower portion of the vagina or out the vaginal opening. Prolapse of the uterus, bladder (cystocele), and rectum (rectocele) can accompany vaginal prolapse and lead to a feeling of pelvic pressure or fullness, or a feeling of a bulge within the vagina. In some cases, these symptoms may be mild in the morning but get worse as the day goes on.

A number of factors can lead to vaginal prolapse, including previous pregnancy, vaginal childbirth and aging. Chronic constipation, loss of muscle tone, lack of estrogen in the body after menopause, and repeated straining or heavy lifting over time may also contribute to weakening of the vaginal muscles and supportive tissues.

If vaginal prolapse does not cause symptoms, or if you can manage your symptoms and they do not disrupt your daily activities, you may not need treatment now. Over time, however, the muscles and ligaments supporting your vagina may continue to weaken, so without treatment the prolapse could get worse. Because of that, it is important to follow up with your doctor as time goes on to monitor your symptoms and the severity of the prolapse.

If vaginal prolapse makes it difficult for you to have a bowel movement, results in urinary problems, causes pain, leads to sexual problems or causes other ongoing symptoms, then treatment usually is necessary. For mild to moderate cases, self-care measures, such as performing exercises called Kegel exercises to strengthen your pelvic muscles, may reduce your symptoms.

Maintaining a healthy weight, avoiding heavy lifting and straining, and taking steps to ease constipation may provide some symptom relief by reducing pressure on the muscles and tissues that support your vagina. Nonsurgical therapy in the form of a pessary — a small device inserted into the vagina to prevent the tissue from prolapsing — is also an option to consider.

For more severe cases of vaginal prolapse or when other measures do not help, surgery can be a useful treatment option. Surgery involves repairing the damaged or weakened tissue, as well as reconstructing the vaginal support, so the vagina will stay in place.

Some surgeons choose to insert a transvaginal mesh kit into the vaginal tissue to provide support. But the U.S. Food and Drug Administration has issued a safety warning about these devices for vaginal prolapse. While transvaginal mesh kits may be successful in some cases, they tend to be associated with complications such as vaginal bleeding, pain, scarring, irritation, discharge and discomfort during sexual intercourse. The mesh also may eventually protrude through the wall of the vagina.

Due to those possible complications, surgeons at Mayo Clinic often use a woman’s own tissue to repair torn or damaged areas associated with vaginal prolapse, rather than mesh. The specific surgical approach used depends on your individual needs and circumstances.

As you consider surgery, be sure to ask questions. The various surgical approaches have different risks and benefits. Talk to your surgeon about these issues and possible long-term side effects and complications. In some cases, vaginal prolapse can recur even after surgery. Ask your surgeon about this possibility and if there are ways to reduce your risk of recurrence.

Take time to understand all your treatment options before you proceed, so you can make a well-informed choice that fits your needs. John Gebhart, M.D., Gynecologic Surgery, Mayo Clinic, Rochester, Minn.

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