Common complaints of women with prolapse are being unable to wear a tampon, urinary and/or fecal incontinence, vaginal dryness or irritation, and pain with intercourse. Symptoms often progress very gradually. And you may make changes in physical or social activities that go unnoticed by others until they become extreme.
Though most women with POP often have no symptoms, some women experience:
- Discomfort (usually pressure or fullness).
- Bleeding from the exposed skin that rubs on pads or underwear.
- Urinary symptoms of leakage, difficulty starting the stream of urine, frequent urinary tract infections.
- Difficult bowel movements—the need to strain or push on the vagina to have a bowel movement.
- A bulge near the opening of the vagina or have a pressure sensation in their pelvic region and or lower abdomen.
As POP worsens, you may notice:
- A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements.
- The feeling of “sitting on a ball”.
- Needing to push stool out of the rectum by placing fingers into or around the vagina during a bowel movement.
- Difficulty starting to urinate or a weak or spraying stream of urine.
- Urinary frequency or the sensation that you are unable to empty the bladder well.
- Lower back discomfort.
- The need to lift up the bulging vagina or uterus to start urination.
- Urinary leakage with intercourse. Though unusual, severe prolapse can block the flow of urine and cause recurrent urinary tract infections or even kidney damage.
Types of Prolapse
Anterior Vaginal Wall Prolapse (Cystocele or Urethrocele)
Anterior vaginal wall prolapse often occurs at the top of the vagina where the uterus used to be in women who have had a hysterectomy. This type of prolapse occurs when the bladder’s supportive tissue, called fascia, stretch or detach from the attachments securing it to the pelvic bones. With this loss of support, the bladder falls down into the vagina. As this condition worsens, the prolapsed pelvic organs may bulge outside the opening of the vagina. Other symptoms may include:
- Urinary frequency, nighttime voiding, loss of bladder control, and recurrent bladder infections—usually due to the bladder not emptying well.
- Stress urinary incontinence (SUI) with activity such as laughing, coughing, sneezing, or exercise) cause by weakened support for the urethra.
Posterior Wall Prolapse (Rectocele or Enterocele)
This type of prolapse occurs when the support tissue or fascia between the vagina and rectum stretches or detaches from its attachment to the pelvic bones. With this loss of support, the rectum or intestines fall (prolapse) into the vagina. Symptoms typically include:
- A bulge sensation.
- Problems having a bowel movement such as straining more with bowel movements and the feeling of not completely emptying the bowels.
- The need to put your finger in or around the vagina or rectum to help empty bowels.
Apical Prolapse (Vaginal Vault Prolapse) or Uterine Prolapse
If a woman has had a hysterectomy, the top part of the vagina (vault) can become detached from the ligaments and muscles of the pelvic floor. Often, uterine or vault prolapse is associated with loss of anterior or posterior vaginal wall support. When the cervix protrudes outside the vagina, it can develop ulcers from rubbing on underwear, sometimes these ulcers will bleed if they become irritated. Most women experience symptoms of bulge or pressure sensation in the pelvis.
Like the vagina and uterus, ligaments, and muscles securely attach the rectum to the pelvis. Infrequently, the supporting structures stretch or detach from the rectal wall and the rectum falls out through the anus. Early on, women may notice a soft, red tissue protruding from the anus after a bowel movement. It can be confused with a large hemorrhoid. Other symptoms may include:
- Pain during bowel movements.
- Mucus or blood discharge from the protruding tissue.
- Loss of control of bowel movements.
Risk factors for rectal prolapse include conditions associated with straining such as chronic constipation or diarrhea, nerve and muscle weakness (paralysis or multiple sclerosis), and advancing age are risk.