What is the differens between bulging, lax vaginal walls and a prolapse?

”What is the difference between a bulging, lax vaginal wall and a prolapse? At my postpartum check-up, my healthcare provider told me I have a bulging vaginal wall, and when I’ve researched my symptoms it makes me think I might have got a cystocele, front wall prolapse. What is the difference between bulging, lax vaginal walls and prolapse, really?”

Reader’s question

OKAY, IT’S LIKE THIS:

Bulging vaginal walls and prolapse are really the same thing. It’s the same anatomical structures that have been displaced and both conditions can cause the same symptoms. The definition of av prolapse is pretty much ‘a lowering of one or more of the vaginal walls and/or cervix’. There are different stages of prolapse, and a small prolapse and a bulging vaginal wall is basically the same thing. 

The thing is that a prolapse is considered a chronic condition where supporting structures such as the pelvic floor muscles and connective tissues have gradually become less firm whereby the tissues and pelvic organs are being pulled down by gravity. This is generally not the case in someone who recently gave birth. 

A RECOVERY PROCESS 

I read somewhere that 70% of all who have given vaginal birth have bulging vaginal walls/some stage of prolapse. However, this condition differs greatly from the diagnosis of prolapse referring to a chronic condition, even if the symptoms are the same. In someone who has recently given birth the body will go through a spontaneous recovery. What looks like a prolapse a month postpartum won’t necessarily look or feel the same 12 months postpartum. The process and level of recovery will of course differ between individuals and there are women who will have remaining symptoms, but it’s impossible to know how much recovery can be expected based on what it looks or feels like shortly after birth. Some have a substantial bulge or bulges due to lax vaginal walls following birth but have no issues at all a short while later. 

We can however be sure that vaginal birth is the greatest risk factor for developing prolapse later in life, typically after menopause. It’s possible that prolapse-like symptoms experienced postpartum may predispose you to developing prolapse later on.

THIS IS HOW I USUALLY EXPLAIN IT: 

This is a vagina seen from the side (the clitoris is to the left and the anus is to the right):

││

(Now imagine that the vagina is the space between the bars and that the bars are the vaginal walls.)        

This is what the vagina looks like during vaginal birth, as it is stretched A LOT by a descending baby:

 (<-B A B Y->)

(Imagine the vaginal walls being pushed to the sides by the baby as it descends)

Due to this, the vaginal walls become significantly stretched and will look something like this immediately after birth: 

S S

(Imagine something loose and mushy which bulges in a variety of directions)

And then the body starts to recover, whereby the vaginal walls looks something like this: 

) (

(Imagine the walls are somewhat distended and that gravity pulls them down making them bulge toward each other in the vagina)

That is, when the walls are more lax, gravity will more easily cause them to bulge.

And in time, it might look something like this: 

││

(Fully recovered vaginal walls, yay!)

Or it might looks like this:

│(

(A bulging back vaginal wall. When enough time has passed and no more spontaneous recovery can be expected, a remaining posterior vaginal bulge may be diagnosed as a rectocele. If symptomatic it can be treated surgically)

Or like this: 

)│

(A bulging front vaginal wall, which may later be diagnosed as a cystocele. This too can be treated surgically if it causes symptoms)

TREATMENT 

Just because a vaginal bulge doesn’t disappear completely on its own but is instead in time diagnosed as a prolapse, surgery isn’t necessarily the next step in treatment. Sometimes, it may be better to choose not to have surgery. If you plan on having a subsequent pregnancy and birth within not too long, it may be better to wait and see if and in that case what type of surgery might be suitable for you. Sometimes age needs to be taken into consideration when deciding whether to have surgery or not. Some surgeries might not last for years and years, and re-operation can only be done so many times, so delaying surgery for as long as possible might be a good idea for some.

│-│

Sometimes, a supporting device such as a pessary can be an effective treatment to reduce a bulge and any associated symptoms. I’ve written more about pessaries here. (Swedish post.) 

You can read more on treatments for prolapse here. (Swedish post)

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PELVIC FLOOR EXERCISES 

If your pelvic floor muscles are weak and an examination shows they may respond well to strengthening exercises – that is, the examination shows that your muscles are intact and haven’t sustained persistent damage from childbirth – you might become asymptomatic from ‘only’ doing pelvic floor exercises. Not because the exercises in themselves will ‘heal’ the prolapse or remove the bulge, but because strong pelvic floor muscles will offer better support to your pelvic floor organs. This will help lift your bulge further away from your vaginal opening, resulting in a decrease in symptoms. 

THE DIFFERENCE BETWEEN A BULGING VAGINAL WALL AND A PROLAPSE

A bulging vaginal wall is actually a small prolapse. However, the two conditions are separated by one big difference; the chance of spontaneous recovery. A bulging wall may well be able to disappear by spontaneous recovery and perhaps a little bit of pelvic floor exercise, whereas a prolapse is considered a more chronic condition which may require surgical treatment if it causes debilitating symptoms.

READ MORE POSTS ON THIS SUBJECT: 

How do i know if I’ve got pelvic organ prolapse?

How do I care for my bulging vaginal walls postpartum?

Exercising/Working out with a prolapse (Swedish post)