Is this a prolapse?

I have been to 3 different drs and have told each one I thought I had a prolapse. I have been having pressure in my bladder and a pain in pelvic and rectum area that gets worse throughout the day. They've told me I don't have prolapse cause it wouldn't cause pain. But not one has actually looked at while bearing down. I just need to know for my sanity. Is this a prolapse or totally normal. I would REALLY appreciate an answer

Doctor Answers 6

Pelvic organ relaxation/prolapse

As one can infer from description of your symptoms and the images provided, it appears that the pelvic area has anatomical changes such as anterior and posterior vaginal wall relaxation, most likely rectocele ( posterior wall) and cystocele (anterior) wall. Also, your perineum looks attenuated ( as the images show). To be able to determine what type of "real" anatomical changes you may have, an exam by experienced gyn. surgeon would be beneficial. A surgeon who has experience with the type of symptoms you describe. If yo need more than correction of your anatomy, you may decide later, once the proper diagnosis of your current condition is made. Hope, it helps.

Best,

Yvonne Wolny MD

Pelvic organ relaxation/prolapse

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

As one can infer from description of your symptoms and the images provided, it appears that the pelvic area has anatomical changes such as anterior and posterior vaginal wall relaxation, most likely rectocele ( posterior wall) and cystocele (anterior) wall. Also, your perineum looks attenuated ( as the images show). To be able to determine what type of "real" anatomical changes you may have, an exam by experienced gyn. surgeon would be beneficial. A surgeon who has experience with the type of symptoms you describe. If yo need more than correction of your anatomy, you may decide later, once the proper diagnosis of your current condition is made. Hope, it helps.

Best,

Yvonne Wolny MD

Prolapse?

The answer to this question is obviously YES, but what is prolapsing is the question.Certainly bladder (cystocele), rectum (rectocele), and gaping opening. None of these cause pain usually so your doctors are focusing on the UTERUS which will hurt when and if it drops. Focus your questions on what is the goal: appearance, function, or discomfort relief. If the uterus is at fault as well, it will be necessary to put off relief until no more children are wanted (vaginal hysterectomy with bladder and rectal vaginal wall suspensions:GYN/UroGYN not plastic surgeon).

Prolapse?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The answer to this question is obviously YES, but what is prolapsing is the question.Certainly bladder (cystocele), rectum (rectocele), and gaping opening. None of these cause pain usually so your doctors are focusing on the UTERUS which will hurt when and if it drops. Focus your questions on what is the goal: appearance, function, or discomfort relief. If the uterus is at fault as well, it will be necessary to put off relief until no more children are wanted (vaginal hysterectomy with bladder and rectal vaginal wall suspensions:GYN/UroGYN not plastic surgeon).

Is this prolapse? Why am I having trouble getting the diagnosis? How can I tell?

Based upon your photos you do appear to have prolapse.  The symptoms of pressure and pain are related.  A woman who has pelvic pain with her menses or with sex is more likely to have pain related to prolapse.  Prolapse essentially is protrusion of your your pelvic organs through your vagina.  If you put two fingers in your vagina and bear down you can tell what kind of prolapse you have.  If you feel pressure along your fingernails then it is your rectum that is prolapsing.  If its pressure on your fingerprints then it is more likely your bladder.  Something hitting the tips of your fingers could be the top of your vagina or your uterus that is dropping down.  I agree that you can get a bunch of answers from different doctors.  I see this all the time.  There are four reasons for this.  One may be that the doctors are not that experienced.  Another is that prolapse on exam can change through the day. (a woman's exam can vary)  Another is that it can be a bit challenging to diagnose.  And the last reason has to do with the fact that some women have prolapse but don't have symptoms - so when doctors look at you anatomy they think its normal because other patients have the same thing and don't feel anything.  

Its pretty obvious from your questions and photos that this is an issue that can be fixed to make you feel better.

Is this prolapse? Why am I having trouble getting the diagnosis? How can I tell?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Based upon your photos you do appear to have prolapse.  The symptoms of pressure and pain are related.  A woman who has pelvic pain with her menses or with sex is more likely to have pain related to prolapse.  Prolapse essentially is protrusion of your your pelvic organs through your vagina.  If you put two fingers in your vagina and bear down you can tell what kind of prolapse you have.  If you feel pressure along your fingernails then it is your rectum that is prolapsing.  If its pressure on your fingerprints then it is more likely your bladder.  Something hitting the tips of your fingers could be the top of your vagina or your uterus that is dropping down.  I agree that you can get a bunch of answers from different doctors.  I see this all the time.  There are four reasons for this.  One may be that the doctors are not that experienced.  Another is that prolapse on exam can change through the day. (a woman's exam can vary)  Another is that it can be a bit challenging to diagnose.  And the last reason has to do with the fact that some women have prolapse but don't have symptoms - so when doctors look at you anatomy they think its normal because other patients have the same thing and don't feel anything.  

Its pretty obvious from your questions and photos that this is an issue that can be fixed to make you feel better.

You might also like...

Prolapse

Yes. I see a Cystocele (bladder drop) and possibly Rectocele ( rectal drop) based on the photos. It is impossible to judge regarding uterine prolapse - need examination

Prolapse

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Yes. I see a Cystocele (bladder drop) and possibly Rectocele ( rectal drop) based on the photos. It is impossible to judge regarding uterine prolapse - need examination

Your vagina looks a bit relaxed

Some docs that lack expertise in pelvic floor reconstruction think that prolapse exists only when everything is hanging outside the vagina (e.g. stage 4 POP). The photo shows a lax vaginal introitus with slight descent of the bladder wall (cystocele) and of the rectal wall (rectocele). These are signs of pelvic organ prolapse and can certainly cause pain. Sometimes the pain is not directly due to the prolapse, but to associated varicose veins within the pelvis (pelvic congestion syndrome). All of this is treatable. All you need is a doc with expertise in pelvic floor reconstruction. A thorough exam is necessary to assess your issues completely.

Your vagina looks a bit relaxed

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Some docs that lack expertise in pelvic floor reconstruction think that prolapse exists only when everything is hanging outside the vagina (e.g. stage 4 POP). The photo shows a lax vaginal introitus with slight descent of the bladder wall (cystocele) and of the rectal wall (rectocele). These are signs of pelvic organ prolapse and can certainly cause pain. Sometimes the pain is not directly due to the prolapse, but to associated varicose veins within the pelvis (pelvic congestion syndrome). All of this is treatable. All you need is a doc with expertise in pelvic floor reconstruction. A thorough exam is necessary to assess your issues completely.

Vaginal prolapse symptoms vary from patient to patient

Dear MC3451:

Sorry to hear of your medical problem.  Based upon your photos alone I can diagnose the following: 1) urethrocele, 2) cystocele, 3 ) rectocele 4) gaping vaginal introitus. I can not tell if your uterus is falling down ie prolapsed from these photos and an exam would be required.   I guess one important question a surgeon needs to ask you is:  do you just want the prolapse fixed ( vaginal reconstruction) or are you also interested in vaginal rejuvenation ie tightening.  Vaginal tightening can be done to enhance friction with intercourse  (internal and external ie the opening is tightened) or just for the purpose of tightening the opening (for appearance purposes but does not really enhance friction during sex.  Or is the only problem PRESSURE AND PAIN? Based upon your description and the little examination I can do with a photo, you have PROLAPSE?    Let us review vaginal reconstruction  and vaginal rejuvenation:

What is vaginal reconstruction?  Vaginal reconstruction is what most urogynecologist have been trained to do...to reconstruct the vagina to give the support back and this does NOT focus on tightening the vagina. The urogyencologist has extensive training and is the most experienced of all surgeons in operating on the relaxed vagina.  The urogyn  is trained by first spending  4 years in a residency in obstetrics and gynecologic surgery and instead of going out to practice they then spend 3 more years of subspecialty training in vaginal reconstruction or the rebuilding of the vagina (when it falls down aka vaginal prolapse - see the next few paragraph for an explanation).  Plastic surgeons, dermatologists, an family practice doctors who have perform cosmetic vaginal surgery do little concept of vaginal reconstruction.  They are not trained in residency to do vaginal surgery nor have they spent 7 years learning vaginal reconstructive surgery like a urogynecologist.  In fact I do not know of any plastic surgical residency in the nation who dedicates more than a few months to training their resident on vaginal surgery.    Vaginal Prolapse is basically the same as the vagina falling down and each area of the vagina which falls has its own descriptive name"

Uterine prolapse - the uterus is falling down into the hollow of the vagina and towards the opening of the vagina in severe conditions the uterus can actually fall  out of the vaginal opening and it hangs between a woman's legs. 'In this situation you would need a sacrocolpohysteropexy or aka hysteropexy.

Cystocele - the deeper portion of the ceiling of the vagina gives way and the bladder which is being supported fall downward into the hollow of the vaginal canal. Often these patients will suffer from frequency and urgency of urination as well as vagina pressure.  If the condition is very severe the patient will have difficulty emptying her bladder.

Urethrocele - the ceiling of the vagina near the opening of the vagina gives way and the urethra sags.  Often these patients will suffer from cough urine leakage ( aka stress urinary incontinence)

Rectocele - the floor of the vagina gives way and the rectum pushes upward into the vaginal canal producing a bulge pushing towards or out of the the opening of the vagina.  Often patients will complain of difficulty emptying their rectum of stool. 

Urogynecologist have been trained to treat the anatomy of the vagina to support each of these structure as well as consider the function of urination and defecation as they perform surgery. Often this surgery needs to be accomplished laparoscopically i.e. small incisions through the abdominal wall.  However most urogynecologist have not been trained in the concept of cosmetic vaginal surgery or  vaginal rejuvenation .When I reviewed your photos above ( difficult to see the details at the opening of the vagina) it appears the ceiling of the vagina is falling downward suggesting either a cystocele, urethrocele or both.   You certainly would benefit from a thorough evaluation by a urogynecologist or a pelvic floor surgeon. 

I would recommend getting a good exam first and then recommend choosing a surgeon who can reconstruct the vagina if your have uterine or vaginal vault prolapse (deepest1/3 of vagina). If you don't have the upper 1/3 prolapsing then you can just get the rest of the prolapse treated ( cystocele, rectocele, and urethrocele) and then have the opening of the vagina restored.  I have been performing vaginal rejuvenation for 17 years and reconstructing vaginas for 25.  I tell you this so you know or should understand I probably know something about vaginal rejuvenation and vaginal reconstruction. Please choose a surgeon wisely --- choose a surgeon with experience, expertise, a great reputation and one who can achieve great results.

John R Miklos MD
Urogynecologist & Cosmetic Vaginal Surgeon

Atlanta ~ Beverly Hills ~ Dubai


Vaginal prolapse symptoms vary from patient to patient

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear MC3451:

Sorry to hear of your medical problem.  Based upon your photos alone I can diagnose the following: 1) urethrocele, 2) cystocele, 3 ) rectocele 4) gaping vaginal introitus. I can not tell if your uterus is falling down ie prolapsed from these photos and an exam would be required.   I guess one important question a surgeon needs to ask you is:  do you just want the prolapse fixed ( vaginal reconstruction) or are you also interested in vaginal rejuvenation ie tightening.  Vaginal tightening can be done to enhance friction with intercourse  (internal and external ie the opening is tightened) or just for the purpose of tightening the opening (for appearance purposes but does not really enhance friction during sex.  Or is the only problem PRESSURE AND PAIN? Based upon your description and the little examination I can do with a photo, you have PROLAPSE?    Let us review vaginal reconstruction  and vaginal rejuvenation:

What is vaginal reconstruction?  Vaginal reconstruction is what most urogynecologist have been trained to do...to reconstruct the vagina to give the support back and this does NOT focus on tightening the vagina. The urogyencologist has extensive training and is the most experienced of all surgeons in operating on the relaxed vagina.  The urogyn  is trained by first spending  4 years in a residency in obstetrics and gynecologic surgery and instead of going out to practice they then spend 3 more years of subspecialty training in vaginal reconstruction or the rebuilding of the vagina (when it falls down aka vaginal prolapse - see the next few paragraph for an explanation).  Plastic surgeons, dermatologists, an family practice doctors who have perform cosmetic vaginal surgery do little concept of vaginal reconstruction.  They are not trained in residency to do vaginal surgery nor have they spent 7 years learning vaginal reconstructive surgery like a urogynecologist.  In fact I do not know of any plastic surgical residency in the nation who dedicates more than a few months to training their resident on vaginal surgery.    Vaginal Prolapse is basically the same as the vagina falling down and each area of the vagina which falls has its own descriptive name"

Uterine prolapse - the uterus is falling down into the hollow of the vagina and towards the opening of the vagina in severe conditions the uterus can actually fall  out of the vaginal opening and it hangs between a woman's legs. 'In this situation you would need a sacrocolpohysteropexy or aka hysteropexy.

Cystocele - the deeper portion of the ceiling of the vagina gives way and the bladder which is being supported fall downward into the hollow of the vaginal canal. Often these patients will suffer from frequency and urgency of urination as well as vagina pressure.  If the condition is very severe the patient will have difficulty emptying her bladder.

Urethrocele - the ceiling of the vagina near the opening of the vagina gives way and the urethra sags.  Often these patients will suffer from cough urine leakage ( aka stress urinary incontinence)

Rectocele - the floor of the vagina gives way and the rectum pushes upward into the vaginal canal producing a bulge pushing towards or out of the the opening of the vagina.  Often patients will complain of difficulty emptying their rectum of stool. 

Urogynecologist have been trained to treat the anatomy of the vagina to support each of these structure as well as consider the function of urination and defecation as they perform surgery. Often this surgery needs to be accomplished laparoscopically i.e. small incisions through the abdominal wall.  However most urogynecologist have not been trained in the concept of cosmetic vaginal surgery or  vaginal rejuvenation .When I reviewed your photos above ( difficult to see the details at the opening of the vagina) it appears the ceiling of the vagina is falling downward suggesting either a cystocele, urethrocele or both.   You certainly would benefit from a thorough evaluation by a urogynecologist or a pelvic floor surgeon. 

I would recommend getting a good exam first and then recommend choosing a surgeon who can reconstruct the vagina if your have uterine or vaginal vault prolapse (deepest1/3 of vagina). If you don't have the upper 1/3 prolapsing then you can just get the rest of the prolapse treated ( cystocele, rectocele, and urethrocele) and then have the opening of the vagina restored.  I have been performing vaginal rejuvenation for 17 years and reconstructing vaginas for 25.  I tell you this so you know or should understand I probably know something about vaginal rejuvenation and vaginal reconstruction. Please choose a surgeon wisely --- choose a surgeon with experience, expertise, a great reputation and one who can achieve great results.

John R Miklos MD
Urogynecologist & Cosmetic Vaginal Surgeon

Atlanta ~ Beverly Hills ~ Dubai


These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.