Symptoms of vaginal wall bulging, urination difficulties are manifestations

Vaginal wall prolapse is common in women and often causes urination dysfunction. Mild symptoms are not obvious, but severe vaginal wall prolapse can lead to urination difficulties, urinary incontinence, and sexual intercourse difficulties. Patients should rest in bed, and severe patients should undergo surgery in a timely manner under the guidance of a doctor.

1. Common symptoms

Lumbar pain, urinary incontinence, sexual intercourse difficulties, sphincter dysfunction, vulvar drooping sensation, urinary incontinence

Mild bulging of the anterior vaginal wall may be asymptomatic, while a feeling of incomplete urination is a manifestation of severe bulging. The most important symptom for women with bulging of the anterior vaginal wall is vaginal prolapse or related symptoms. They feel that something has prolapsed from the vagina. When the abdominal pressure increases during labor, coughing, exertion, or when there is urine accumulation in the bladder, the object increases in size and urine overflows. It shrinks or even disappears after bed rest or urination. Patients have a feeling of vaginal fullness, a feeling of pelvic falling, stress urinary incontinence or a feeling of incomplete urination, lumbar pain that worsens after standing for a long time, and difficulty in sexual intercourse. Often patients need to push up on the bulging vagina to empty their urine.

2. Clinical classification:

1. Grade I (mild): The bulging of the anterior vaginal wall has reached the edge of the hymen but has not yet protruded from the vaginal opening.

2. Grade II (moderate): Part of the anterior vaginal wall bulges out of the vaginal opening.

3. Grade III (severe): The anterior vaginal wall has completely bulged out of the vaginal opening.

Signs include vaginal prolapse, stress urinary incontinence, and anterior vaginal wall bulging. Stress urinary incontinence occurs in 39%.

With a full bladder, the patient first takes the lithotomy position to examine the external genitalia. If no corresponding signs are found or the maximum degree of prolapse is uncertain, a standing position examination is performed. If no obvious prolapsed tissue is found, gently separate the labia minora to expose the vestibule and hymen, assess the integrity of the perineum, and estimate the size of the prolapsed tissue. Pressing the posterior vaginal wall with the posterior leaf of the speculum helps expose the anterior vaginal wall. Then have the patient hold his breath or cough hard to observe the prolapse of the pelvic organs, which helps to distinguish between lateral wall defects and central defects. The former is manifested as the disappearance or separation of the vaginal lateral grooves; while midline bulging is manifested as the presence of vaginal lateral grooves. When the anterior vaginal wall descends, the bladder descends, with or without excessive urethral movement. If there is a concurrent urethral bulge and abdominal pressure increases, the urethra slides downward and forward in a rotational manner.

Studies have shown that the difficulty in urination in women with severe prolapse is attributed to urethral obstruction. When the prolapse is alleviated, urethral dysfunction is exposed, accompanied by stress urinary incontinence. For women with severe prolapse, it is very important to check the urethral function after the prolapsed material is restored. After the prolapse is restored, if the patient urinates normally but still leaks urine after coughing hard or Valsalva maneuver, it indicates urethral sphincter dysfunction.