What Is Vaginal Vault Prolapse?

Vaginal prolapse is divided into anterior vaginal wall prolapse and posterior vaginal wall prolapse. Anterior vaginal wall prolapse is also known as bladder prolapse, which is the decline of the anterior vaginal wall and bladder from the normal position; prolapse of the posterior vaginal wall and rectum It is the back wall of the vagina and the rectum descending from the normal position.

Lu Ye	(Deputy Chief Physician)	Department of Obstetrics and Gynecology, Peking University First Hospital
Bi Yan	(Chief physician)	Department of Obstetrics and Gynecology, Peking University First Hospital
Bai Wenpei	(Chief physician)	Department of Obstetrics and Gynecology, Peking University First Hospital

The vagina is divided into anterior vaginal wall and posterior vaginal wall, so vaginal prolapse is also divided into anterior vaginal wall prolapse and posterior vaginal wall prolapse, which is a common disease of middle-aged and elderly women. Vaginal prolapse is defined as damage or defects in the support structure of the pelvic floor. The anterior and posterior walls of the vagina descend from the normal position along the vagina. In severe cases, they fall out of the vaginal opening. Vaginal prolapse is often accompanied by uterine prolapse or stress urinary incontinence (cough, exertion, involuntary leakage during running and jumping) or dysuria, frequent urination and other symptoms, which seriously affect women's quality of life and cause psychological burden on many women. It's called "social cancer."

Western Medicine Name: Vaginal prolapse
Affiliated Department: Gynecology and Pediatrics-

Contagious: Non-contagious
Whether to enter health insurance: Yes

Vaginal prolapse disease classification

Causes of Vaginal Prolapse

There are many causes of vaginal prolapse, generally caused by damage and defects in the support structure of the pelvic floor, such as damage to pregnancy and childbirth, long-term increased abdominal pressure (such as chronic cough, long-term constipation, etc.), degenerative changes, genetic factors Wait. It is also related to some urethral vaginal surgery, pelvic mass compression, excessive body mass index, and effects of hormone levels. Among them, the damage of pelvic floor during pregnancy and childbirth is the most common cause.

Female pelvic floor, especially the part related to controlling urination and organ support, has always been considered a complex problem. It is a controversial area among urologists, gynecologists and anatomists. Although the anatomy of the pelvic floor muscles, ligaments, nerves, and blood vessels is already clear, normal pelvic floor function depends on the complex interaction of intact muscles, connective tissues and nerve distribution, and is a dynamic balance system. One type of disease caused by pelvic floor support tissue degradation due to relaxation and damage is female pelvic floor dysfunction (including uterine prolapse and prolapse of anterior and posterior vagina, etc.).

Vaginal prolapse staging

Indexing of prolapse of the anterior and posterior wall of the vagina (China's indexing method):

degree bulging vaginal wall is located inside the vagina

degree part of vaginal wall swelled out of vaginal opening

degree vaginal wall completely bulged out of the vaginal opening

At present, the POP-Q (pelvic organ prolapse quantitive examination) classification is used internationally, and prolapse is divided into 0-4 stages. ^[1]

Clinical symptoms of vaginal prolapse

Clinical symptoms of vaginal prolapse: mild patients are mostly asymptomatic, those with moderate to severe symptoms may have the following symptoms: vaginal prolapse, friction, running water, bleeding, falling sensation, lumbosacral pain, difficulty urinating or stress urinary incontinence or Frequent urination, unclean urination, and difficulty in stool.

Because many patients with prolapse will have lower urinary tract symptoms, corresponding auxiliary examinations, urinary tract activity measurements, bladder function assessment, urodynamic tests, etc. are necessary, and even some patients with ureteral dilatation require imaging examinations. .

Vaginal prolapse is not difficult to diagnose through medical history and clinical examination, but the diagnosis also judges indexing, local erosion, cystitis, and stress urinary incontinence.

Treatment of Vaginal Prolapse

Treatment of vaginal prolapse:

Non-surgical treatment of vaginal prolapse

Non-surgical treatment is preferred for patients with mild and moderate patients. Non-surgical treatment is also suitable for patients who cannot tolerate surgery, are waiting for surgery, and are unwilling to undergo surgery. Current non-surgical treatments include lifestyle interventions, pelvic floor rehabilitation (pelvic floor muscle training, biofeedback therapy, etc.), pessary, etc. The goal of treatment is to prevent prolapse, increase the strength, endurance, and support of pelvic floor muscles, and avoid or delay surgical intervention. ^[2]

Vaginal prolapse surgery

Surgical treatment is suitable for patients with moderate to severe prolapse, those who fail conservative treatment, or those who do not want conservative treatment. It is mainly symptomatic prolapse, or the degree of prolapse is above II degree with significant progress. All patients should be given the opportunity to try conservative treatment.

Surgical pathways include transvaginal, transabdominal, and laparoscopic, or a combination of these. Depending on the degree and location of the prolapse, the surgery should include repair of the anterior vaginal wall, the top of the vagina, the posterior wall of the vagina, and the perineal body. It is also possible to perform surgery against urinary incontinence and incontinence simultaneously.

Complications of vaginal prolapse surgery are: bleeding, infection, organ damage, local hematoma formation, mesh erosion and exposure, contracture, difficulty in sexual intercourse, urinary infection and new emptying disorder, fistula. Formation etc.

There are many surgical methods for pelvic organ prolapse, which need to be determined by comprehensively considering the type and severity of prolapse, the operator's experience, the patient's tendency and the expected goals of the operation. ^[3]

Vaginal prolapse rehabilitation care

After surgical treatment, attention should be paid to prohibiting heavy physical activity or lifting heavy objects within three months. When necessary, topical vaginal estrogen can be applied to promote wound healing.

Vaginal prolapse should be intervened and treated early to prevent it from happening. Since pregnancy and childbirth injuries are the main causes, it is recommended that female friends be screened for pelvic floor function early in the postpartum period, and pelvic floor training and biological Feedback therapy and electrical stimulation treatment, early intervention before the occurrence of typical clinical symptoms, can reduce the occurrence of prolapse.