Vaginal Prolapse | Don't be ashamed of this, let's talk about it!

It is common for many women, especially after having children or as they age, to feel discomfort and heaviness in the lower abdomen. Sometimes it feels like "something like a ball has come down" or "I feel like I am sitting on a ball." Although many people are embarrassed to talk about such discomfort, this is a condition that can be explained medically. Today we are talking about this condition called vaginal prolapse.

Simply put, what is vaginal prolapse?

Imagine, in the lower part of our abdomen, that is, in the pelvic area, there are many important organs. Things like the uterus, vagina, bladder, rectum. All of these organs are held in their proper places by a strong network of muscles and tissues. We call this the pelvic floor. It's like lifting something from under an umbrella, this muscular system holds our organs in place.

Over time, especially due to factors like having children, aging, and lifting weights, these pelvic floor muscles can gradually weaken. Then, the strength to hold the organs in place becomes insufficient, and the organs begin to sag and fall down. This is what we call a ``prolapse,'' or 'dropping.''

Vaginal prolapse is when the upper part of the vagina weakens and drops down from its normal position into the vagina. Sometimes this may only be a slight prolapse. In severe cases, the vaginal tissue may be so prolapsed that it is visible.

Can these degradations happen one after another?

Yes, there are different types of prolapse depending on where it occurs and which organ is descending. Because when the pelvic floor is weak, it can affect not just one organ, but several organs.

What are the symptoms of this condition?

Sometimes, if you have a small prolapse, you may not notice any symptoms. It may only be discovered when a doctor examines you. However, many people may experience one or more of the following symptoms.

• A feeling of heaviness, fullness, or pain in the lower abdomen. This discomfort may increase as the day progresses, after standing for a long time, lifting heavy objects, or coughing.
• Back pain .
• Feeling like there is something like a lump or ball inside the vagina.
• Feeling like "something is coming out of the vagina."
• Urinary incontinence is the involuntary loss of urine when coughing, laughing, or sneezing.
• Frequent urinary tract infections .
• Difficulty defecating .
• Pain or discomfort during sexual intercourse.
• Difficulty inserting objects such as tampons into the vagina.

Why is this happening? What are the main reasons?

There are several reasons why the pelvic floor muscles we talked about earlier may become weak.

• Having children: A major cause is childbirth, especially vaginal delivery. Having multiple children, a long labor, or a baby weighing more than 9 pounds increases the risk.
• Menopause: With menopause, the body's production of the hormone estrogen decreases. This hormone estrogen is very important for keeping the pelvic floor muscles strong. So when estrogen levels decrease, these muscles can weaken.
• Surgery: Women who have had a hysterectomy are at increased risk of vaginal prolapse.
• Aging: The risk of this condition increases as muscles naturally weaken with age.
• Frequent heavy lifting: Frequent lifting of heavy objects (such as buckets of water, gas cylinders) can put continuous pressure on the pelvic floor and weaken the muscles.
• Other causes: Obesity, frequent straining due to constipation, and chronic coughing caused by diseases like asthma can also put pressure on the pelvic floor and lead to this condition.

What are the treatments for this?

Treatment for this depends on many factors, including your age, the severity of the condition, your general health, and whether you plan to have children or be sexually active in the future. So it's important to talk openly about this with your doctor.

Treatment can be divided into two main parts.

1. Non-surgical treatments

These are usually the first treatments used when the condition is not too severe.

• Kegel exercises: This is the most important and easiest. This strengthens the muscles of the pelvic floor. Tighten the muscles around the vagina and anus as if you are stopping the flow of urine , hold for a few seconds, and then slowly relax. You can do this several times a day, about 10 times at a time. You can do this exercise anywhere, anytime.
• Vaginal pessary: ​​This is a small, ring-shaped device made of rubber or plastic. A doctor will choose the right size for you and insert it into your vagina. It provides support to your lower genitals and keeps them elevated. It should be cleaned regularly and removed before sex.

2. Surgical treatments

If the condition is severe or other treatments are not successful, your doctor may recommend surgery.

• Vaginal vault suspension: This surgery involves attaching the lowered vagina to strong ligaments inside the pelvis and then lifting it back up.
• Sacrocolpopexy: This involves lifting the vagina using a mesh and attaching it to the lowest bone in the spine. This is usually done laparoscopically through several small incisions in the abdomen.
• Colpocleisis: This involves stitching the vagina shut. The risk of a prolapse occurring again after this surgery is very low. However, you cannot have sex through the vagina after this surgery . Therefore, you should talk to your doctor before making a decision about this.

What can we do to prevent this situation?

Although it cannot be completely prevented, there are several things we can do to reduce the risk.

• Do Kegel exercises regularly.
• Maintaining a healthy weight .
• Avoid smoking (smoking can cause coughing and increase pressure on the pelvic floor).
• Use proper posture when lifting weights . Keep your back straight and bend your knees when lifting weights. Do not twist and lift weights all at once.
• Eat fiber-rich foods and drink plenty of water to prevent constipation.

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