When a woman’s vagina slips out of position, it causes prolapse in elderly ladies, and this condition is known as vaginal vault prolapse (VVP). Also known as vaginal prolapse, the top of the vagina sags, and falls down into the vaginal canal. One may feel pressure or a feeling of fullness in the birth canal. Also, the perception that something has slipped out is felt. In severe critical situations, the vagina may extend outside the opening of vagina.

Types

Different procedures are used for vaginal vault prolapse. These include:

Vaginal approach

The vaginal vault is accessed for the birth canal. People who have had a vaginal hysterectomy treatment, i.e., removal of their uterus go for this.

Abdominal approach

An incision may be done to approach and mend the vaginal vault prolapse. Normally, used in severe cases.

Laparoscopic Approach

Tiny cuts are made, and the surgeon and his team are guided by a laparoscope-a thin tube equipped with a camera-while making the repair.

Is Vaginal Prolapse Common?

Yes, this is a somewhat common condition. One-third of women, or assigned female at birth (AFAB), are known to have some or the other type of pelvic area prolapse during their lifespan.

Adult women who have delivered a lot of babies through natural birth are likely to acquire this condition later in their life.

Causes

Weakness in the pelvic floor muscles and connective tissues.
Older women who have neared their menopause. As the estrogen level lessens in such females, their pelvic floor diminishes.
Adult women who have had multiple deliveries.
Abnormal fat accumulation, such as obesity, puts pressure on the vaginal walls.
Women who are born with a rare condition like bladder exstrophy.
Lifting heavy objects or carrying out intense physical activity.
Age

Symptoms

Throbbing pain in the birth canal, i.e., pressure in the vagina is felt in this condition. Different symptoms & signs include:

Feeling some heaviness or pressure in the birth canal or pelvis.
A bulging of tissue that may protrude from the vagina, and the necessity to put finger pressure on this bulge in order to urinate or empty the intestines.
Increased urinary infections.
Vaginal hemorrhage and discharge.
Weak urine flow, straining to urinate.
Difficulties emptying the bladder.
Pain during sexual intercourse.
Difficulty in the use of tampons.

Diagnosis

Healthcare experts may recommend some tests. These are listed below:

Review of the surgical and medical history.
Complete physical examination.
Ultrasound or MRI are rarely required.
On rare occasions, urodynamic testing, or UDS, to find out the working of the bladder and urethra can be recommended by the healthcare expert.

Risks and Complications

This medical surgery carries certain risks and expected complications. These can include:

Surgical site being infected
Bleeding or hematoma formation
Nearby organs or structures getting damaged
Prolapse likely to recur
Bowel complications
Unfavorable reactions to anesthesia

Surgery for Vaginal Vault Prolapse

The medical procedure for this condition will vary with each individual, based on the patient’s case and approach. Although females who cannot have a medical operation may benefit from pelvic floor exercises and pessary rings. The patient’s history, general health, and specific vaginal vault prolapse all influence her surgical options.

The steps involved in the procedure are as follows:

1) The Procedure

Anesthesia

- Intravenous (IV) anesthetics are normally given to bring about sedation or a sleeping effect.
- Depending on the complexity of the surgery and the woman’s preference it can be
  - Local anesthesia or
  - General anesthesia.

Approaching the Vaginal Vault

- The surgeon and his team will make the necessary cuts so that the vaginal vault can be examined and figure out the prolapsed tissues.

Repair and Reconstruction

The operating surgeon will mend the weakened tissues, often by using sutures to reinforce and tighten the supportive structures. In some cases, mesh may be used to provide additional support.

Closing the Incisions

Once the repair is complete, the incisions will be closed using dissolvable stitches or sutures.

2) Recovery

Once the surgery is over, the patient is monitored for a certain period to make sure the healing is proper. The healthcare instructions to be followed include:

Avoid physical activities that are challenging.
Using prescription painkillers as directed.
Keeping the incision site clean and taking care of it.
Using tampons and avoiding sexual activity unless the doctor permits it.
Follow-up appointments to monitor the condition for a speedy recovery.

Prevention

One cannot totally get rid of vaginal prolapse. Although there are several beneficial lifestyle habits one can follow to reduce the risk of getting vaginal prolapse. These may include:

Regular exercise, such as Kegel exercises.
Keeping an ideal body mass index and sticking to a free heart-healthy diet plan.
Halt smoking, as cigarettes tend to make one cough more.
In case of carrying heavy objects, ensure proper lifting techniques. For example, in a multi-story building having an elevator, the elevator can be used to move up and down and carry items along with.