What Causes Vault Prolapse?

Vault prolapse occurs when the vaginal vault drops into the vaginal canal.

The pelvis is the area between the hip bones and it harbors the pelvic organs, which include the uterus, cervix and vagina (parts of the reproductive system); intestines and the rectum (parts of the digestive system); and the urinary bladder and urethra (parts of the genitourinary system). Any of these organs can sag or slip downwards (prolapse) when their supporting muscles and surrounding fibers become weak, torn or stretched. The vault prolapse can occur in women who underwent surgery for the removal of the uterus (hysterectomy). The vaginal vault in the inner expanded part of the vagina forms the roof of the vaginal canal. During vault prolapse, the vaginal vault drops down into the vaginal canal. A vault prolapse may be accompanied by the bulging of the small bowel against the vaginal wall (enterocele). Other types of prolapse that can occur through the vagina are

• Uterine prolapse: This refers to the prolapse of the uterus and cervix (neck of the uterus) down into the vagina. In severe cases, the prolapsed parts may come out through the vaginal opening.
• Cystocele: In this condition, the bladder bulges into the vagina.
• Rectocele: In this condition, the rectum (the last part of the large bowel) bulges into the vagina.

Over one-third of the women in the United States have experienced some form of pelvic prolapse in their lives. Vault prolapse can occur whenever the supporting structures in the pelvis become weak, torn or stretched. The causes include

• Vaginal birth, especially multiple childbirths
• Delivery of a large baby (weighing more than 9 pounds)
• Surgery like hysterectomy (uterus removal)
• Radiation therapy in the pelvic area
• Menopause
• Lifting heavyweights
• Aging
• Extreme physical activity
• Being overweight
• Long-term constipation or straining during bowel movements
• Long-term cough
• Genetic reasons (having a family history of pelvic organ prolapse)

The symptoms of vault prolapse may vary, depending on the severity of the prolapse and the presence of another pelvic prolapse like an enterocele. In early or mild cases, there may not be any noticeable symptoms.

The symptoms may include

• A feeling of fullness or heaviness in the vaginal area
• Presence of pain or discomfort in the pelvic area, which becomes worse while standing, coughing, straining or lifting weights
• Lower back pain
• Feeling a mass bulging inside or outside of the vaginal canal, which may cause discomfort during walking
• Bleeding through the vagina
• Inability to control urine (incontinence)
• Urinary tract infection (UTI)
• Difficulty in having bowel movements
• Discomfort during sexual intercourse
• Problems inserting a tampon

The treatment for vault prolapse depends on many factors, such as

• Severity of prolapse
• Symptoms
• The patient’s age
• The general health of the patient
• Presence of any other health conditions, such as diabetes and heart disease

In early or mild cases, the doctor may advise watchful waiting or observation. They may prescribe nonsurgical treatments, such as

• Kegel exercise (exercises for strengthening pelvic muscles): To do  these exercises, the woman needs to tighten her pelvic muscles as if she is trying to hold back urine. This position has to be held for a few seconds. The entire process of tightening and releasing the muscles must be repeated about 10 times. This can be done up to four times a day.
• Vaginal pessary: This is a small doughnut-shaped device made of plastic or rubber. It is inserted inside the vagina. A vaginal pessary provides support to the pelvic structures.

In severe cases of vault prolapse, surgery may be done. Surgery options include

• Vaginal vault suspension: In this procedure, the vagina is attached (fixed) to the ligaments inside the pelvis that used to hold it up.
• Laparoscopic sacrocolpopexy: This is a minimally-invasive surgery that is done through small incisions in the abdomen. It involves strengthening the pelvic floor. During surgery, a surgical mesh is attached from the vagina to the tailbone (sacrum).