Anterior and posterior vaginal wall prolapse

Prolapse of the anterior and posterior walls of the vagina is quite harmful to women. It can easily lead to bladder prolapse and urethral prolapse, especially bladder prolapse, which often causes urinary incontinence. There are many reasons for vaginal prolapse, the most common of which is related to childbirth. After childbirth, if you do not get good recovery, it is easy to cause such symptoms. Let's take a look at this aspect.

Anterior and posterior vaginal wall prolapse

The base of the bladder and urethra are close to the front wall of the vagina. The supporting tissue of the anterior vaginal wall is mainly the pubovesical cervical fascia and the deep fascia of the urogenital diaphragm. The former originates from the back of the pubic symphysis and the pubic arch, extends forward and outward along the bottom of the bladder, and attaches to the front of the cervix. The fascia surrounding the vagina joins superiorly with the fascia surrounding the cervix and joins with the cardinal ligament. The vesicocervical ligaments on both sides of the cervix also play an important role in maintaining the normal position of the bladder.

When the fetal head passes through the vagina during delivery, the pubovesical cervical fascia and the pubococcygeus muscle are inevitably extremely stretched or even torn. If you do not get enough rest in the early postpartum period, especially if you engage in physical labor too early, the vaginal supporting tissue will not be able to return to normal, and the bladder and the upper 2/3 of the anterior wall of the vagina adjacent to it will bulge downward, which is called cystocele. If the anterior segment of the pubovesical cervical fascia supporting the urethra is damaged, the urethra and the lower 1/3 of the anterior wall of the vagina adjacent to it will rotate backward and descend with the external urethral orifice as a fixed point, forming a urethral bulge.

symptom

In mild cases, there are no obvious symptoms. In severe cases, patients may feel a sense of falling, back pain, and a lump coming out of the vagina, which is actually a bulging anterior vaginal wall. The lump becomes larger and the feeling of falling becomes more obvious when standing for a long time, after strenuous activity or when abdominal pressure is increased. If only the anterior vaginal wall is combined with cystocele, the posterior urethral bladder angle becomes sharp, often leading to dysuria and urine retention, and even secondary urinary tract infection. If the anterior wall of the vagina bulges completely, the posterior angle of the urethra and bladder disappears, and urine overflows when the abdominal pressure increases due to coughing, holding the breath, etc., which is called stress urinary incontinence.

Signs

Do not urinate during the examination. You can see that the anterior vaginal wall bulges toward the vaginal opening in a spherical shape. The vaginal mucosa has lost its normal thickness and wrinkles, and it is soft to the touch. It shrinks when lying flat and can be retracted by hand. The degree of bulging of the anterior vaginal wall after holding your breath downward is divided into mild, moderate, and severe. Mild prolapse: The protruding bladder protrudes downward along with the anterior wall of the vagina and has reached the edge of the hymen but has not yet protruded out of the vagina.

Moderate prolapse: Part of the anterior vaginal wall protrudes outside the vaginal opening.

Severe prolapse: The anterior vaginal wall completely protrudes outside the vaginal opening.