Is it normal to have granulation tissue on the vaginal wall?

Anterior vaginal wall prolapse is often accompanied by cystocele and urethral protrusion, with cystocele being more common. Anterior vaginal wall prolapse can exist independently, and it often coexists with posterior vaginal wall prolapse. Do not urinate during the examination. You can see that the anterior vaginal wall protrudes toward the vulva in a spherical shape. The vaginal mucosa loses its normal thickness and wrinkles and is soft to the touch. It becomes smaller when lying flat and can be retracted with force. The degree of bulging of the anterior vaginal wall after holding your breath is divided into light, medium and severe.

During vaginal examination, vaginal introitus laxity is often associated with old perineal lacerations. The anterior wall of the vagina is a hemispherical protrusion that is soft to the touch. The mucosa at this point becomes soft and crystal clear, and the wrinkles disappear. The protruding anterior vaginal wall is clearly visible when the patient holds her breath.

The bottom of the bladder and the urethral opening are close to the front wall of the vagina. The applicable tissues of the anterior wall of the vagina are mainly the metatarsal bladder, cervical muscle fascia and the deep muscle fascia of the urogenital diaphragm. The former starts from the posterior side of the ischial tuberosity and the pubic arch, flexes and stretches forward along the bottom of the bladder, and adheres to the front of the cervix. The muscle fascia around the vagina connects upward with the muscle fascia tightly surrounding the cervix and converges with the main cruciate ligament. The bladder cruciate ligaments on both sides of the cervix also play an important role in maintaining the normal position of the bladder.

During labor, when the fetus's head passes through the vagina, the metatarsal bladder, cervical muscle fascia and pubococcygeus muscle are inevitably extremely stretched or even torn. If the woman does not sleep well in the early postpartum period, especially if she does physical work too early, the supporting tissues in the vagina will not be able to recover, and the bladder and the adjacent upper 2/3 of the anterior vaginal wall may protrude downward, which is called cystocele. If the front end of the metatarsal bladder, cervical muscle fascia supporting the urethral opening is damaged, the urethral opening and the adjacent lower 1/3 of the anterior vaginal wall will rotate and drop backward with the external urethral opening as the support point, resulting in urethral protrusion.

Clinical symptoms of anterior vaginal wall prolapse

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Anterior vaginal wall prolapse may cause no obvious symptoms. In severe cases, the patient will fall down actively, feel back pain, and small pieces of objects will come out of the vagina. In fact, it is the protrusion of the front wall of the vagina. When standing for a long time, after strenuous activity or when abdominal pressure is increased, the small mass will expand and the feeling of falling will be more obvious. If only the anterior vaginal wall is combined with cystocele, the posterior angle of the urethral opening becomes sharp, often resulting in difficulty in urination and urine retention, and even secondary urethral infection. If the anterior wall of the vagina is completely protruding, the posterior angle of the bladder at the urethral opening collapses, and urine overflows when the abdominal pressure is increased by coughing, holding the breath, etc., which is called supportive urinary incontinence.