Vaginal prolapse, also known in Traditional Chinese Medicine as vaginal prolapse, is also known as vaginal prolapse, vaginal itching, or gourd-shaped prolapse, depending on the specific form of the protrusion. It refers to a woman’s uterus protruding downward, sometimes protruding outside the vulva, or bulging of the vaginal wall. This condition is often caused by excessive loss of Qi and blood during childbirth, leading to Qi deficiency or kidney instability. It is also referred to in modern medicine as uterine prolapse and vaginal wall bulging.
Clinical classification
Yin prolapse is mainly divided into three types: Qi deficiency and sinking, kidney qi deficiency, and damp heat.
1. Qi deficiency and sinking
The main symptoms are a drooping mass in the genitals, which may even protrude from the vaginal opening. This is exacerbated by excessive exertion and may lead to a distended lower abdomen. These symptoms are often accompanied by shortness of breath, reluctance to speak, weakness in the limbs, a dull complexion, frequent urination, a pale tongue with a thin coating, and a weak and thready pulse. Some patients may also experience a profuse, white, and watery vaginal discharge.
2. Kidney Qi deficiency
The main symptoms are a drooping mass in the genitals that may even protrude from the vaginal opening, aggravated by excessive exertion, and a distended lower abdomen. Symptoms may include soreness of the waist and knees, dizziness, tinnitus, frequent urination, frequent urination at night, a pale tongue with a thin coating, and a deep, weak pulse.
3. Damp-heat
The main symptoms are a genital swelling that may protrude beyond the vaginal opening, redness and swelling of the vulva, and discomfort such as pain or itching. These symptoms are often accompanied by irritability, spontaneous sweating, a bitter and dry mouth, burning and painful urination, a red tongue with a yellow coating, and a stringy or slippery pulse. Some patients may also experience increased and yellowish vaginal discharge.
Epidemiology
High-risk population
It is common in postmenopausal women who have experienced one or more vaginal births, especially those with poor economic conditions, poor nutritional status, and who engage in high-intensity physical labor.
Causes
Overview
Vaginal prolapse is often caused by excessive damage to Qi and blood during childbirth, leading to Qi deficiency or kidney deficiency. In addition, constitutional weakness, exogenous dampness and heat can also lead to yin prolapse.
Basic cause
1. Birth injury
Reasons such as delivery surgery or difficult delivery can cause women to sweat too much or bleed too much, resulting in severe damage to qi and blood, weakening the qi’s retaining function, and causing yin prolapse.
2. Physical weakness
For example, congenital pelvic floor tissue dysplasia, pelvic floor tissue atrophy and degeneration in elderly patients, excessive sexual activity, excessive childbirth, etc. will cause physical weakness, consume essence and energy, damage the kidneys, lead to weakened kidney’s retention function, and cause yin prolapse.
3. Exogenous dampness and heat
According to Traditional Chinese Medicine, the liver is another important internal organ for women. When damp heat invades the liver and gallbladder meridians, it can affect the normal function of women’s endocrine and reproductive organs, leading to genital prolapse.
Risk factors
1. People with chronic cough, difficulty in defecation, large amounts of ascites, huge abdominal tumors and other diseases are prone to vaginal prolapse.
2. Frequently engage in high-intensity physical labor, such as standing for long periods of time, carrying things on shoulders, lifting weights, etc.
3. People who are overweight or obese have a greater risk of developing vaginal prolapse.
symptom
Overview
The main clinical manifestation of vaginal prolapse is a swelling in the genitals that falls down and even prolapses out of the vaginal opening. Patients with mild cases generally have no symptoms, while patients with severe cases often feel pain in the lumbar and sacral area or a feeling of heaviness in the lower abdomen.
Typical symptoms
1. Vaginal prolapse: The uterus often protrudes from the vaginal opening during walking, squatting, or defecation. Initially, the uterus may shrink or disappear while resting. However, in severe cases, it may not retract even after rest and must be manually reinserted into the vagina. Some patients also have difficulty with manual reinsertion, resulting in prolonged prolapse of the uterus outside the vaginal opening, which can be extremely inconvenient for the patient.
2. Conscious feeling of falling
Most patients may experience varying degrees of lumbar and sacral soreness or a feeling of heaviness, and a feeling of heaviness in the lower abdomen. The symptoms are more obvious after standing for too long or being tired, and are relieved by bed rest.
3. Decreased libido
Patients may have decreased libido and deep vaginal pain during sexual intercourse.
Associated symptoms
It may be accompanied by difficulty urinating or defecating, constipation, enuresis, and stress incontinence (urine leakage when actions that increase intra-abdominal pressure, such as laughing, coughing, and holding the breath, occur).
complication
In severe cases, part of the vagina or cervix may protrude from the body for a long time. Repeated friction with clothing can cause vaginal or cervical tissue hyperplasia, infection, and ulcers. Cystitis or urinary tract infection is also a common complication.
examine
Scheduled inspection
In addition to routine TCM examinations such as observation, auscultation, questioning, and palpation, doctors may also perform Western medicine gynecological examinations to gain a preliminary understanding of the patient’s condition. Subsequently, cervical cytology, ultrasound, and MRI examinations may be performed depending on the specific situation.
Physical examination
1. Four Diagnoses of Traditional Chinese Medicine
Doctors can conduct examinations through the four diagnostic methods of traditional Chinese medicine: observation, auscultation, inquiry and palpation, which include observing the patient’s condition, carefully inquiring about the patient’s medical history, and taking the pulse.
2. Gynecological examination
After the patient takes the lithotomy position, the degree of uterine prolapse, bulging of the anterior and posterior vaginal walls, and perineal tear are examined.
Laboratory tests
For patients with cervical ulcers, doctors may recommend cervical cytology to rule out cancer.
Imaging examinations
Pelvic ultrasound, pelvic MRI, etc. can be used to observe whether there are other abnormalities in the pelvis.
diagnosis
Diagnostic principles
Doctors can usually diagnose the condition based on observation, auscultation, questioning and palpation. If necessary, they can also combine auxiliary examinations such as Western medicine gynecological examination, cervical cytology, ultrasound examination, magnetic resonance imaging and other auxiliary examinations to further understand the condition.
Diagnostic basis
1. Medical history
Most of them have a history of birth injury, overbirth, and chronic diseases, such as long-term cough and constipation.
2. Clinical symptoms
An object may protrude from the vagina, even out of the vaginal opening. This protrusion may diminish or disappear with bed rest, but become more pronounced after prolonged standing or excessive exertion. Symptoms may also include lumbar pain, a feeling of loss in the lower abdomen, difficulty urinating, frequent urination, or urinary retention, incontinence, and constipation. Prolonged friction may lead to ulcers on the cervix and vaginal wall, and a profuse, yellowish vaginal discharge.
3. Clinical classification
(1) Uterine prolapse grade
Uterine prolapse is divided into 3 degrees based on the lowest point of the uterus when the patient lies flat and holds his breath.
① Grade I: Mild: The external os of the cervix is less than 4 cm away from the edge of the hymen and has not reached the hymen; Severe: The external os of the cervix has reached the edge of the hymen and the cervix is visible at the vaginal opening.
② Grade II: Mild: The cervix prolapses outside the vaginal opening, and the uterine body remains in the vagina; Severe: The cervix and part of the uterine body prolapse outside the vaginal opening.
③ Grade III: The cervix and uterine body are completely protruding from the vaginal opening.
(2) Clinical grading of anterior vaginal wall prolapse
According to the degree of anterior vaginal wall bulging or prolapse during examination, it is clinically divided into 3 degrees:
① Grade I: The protruding bladder protrudes downward along with the anterior vaginal wall and remains in the vagina.
② Grade II: Part of the anterior vaginal wall is exposed outside the vaginal opening.
③ Grade III: The anterior vaginal wall is completely protruded outside the vaginal opening.
(3) Clinical grading of posterior vaginal wall prolapse
Clinically, it can be divided into 3 degrees according to the degree of protrusion:
① Mild: When the patient holds his breath and pushes down, there is an obvious protrusion of the posterior wall.
② Moderate: When the patient holds her breath and pushes down, the posterior wall of the vagina bulges to the hymen mark.
③ Severe: When the patient holds her breath and exerts force, the posterior vaginal wall protrudes beyond the hymen mark.
Differential diagnosis
1. Cervical elongation
The uterus is still in the pelvic cavity, the cervix is slender and columnar, there is no bulging of the anterior and posterior walls of the vagina, and the anterior and posterior domes have not dropped.
2. Submucosal uterine fibroids (pedunculated prolapse type)
Clinical manifestations of this condition include heavy menstrual flow, prolonged or shortened menstrual cycles, and abnormal vaginal discharge. Gynecological examination may reveal a red, firm, prolapsed mass at the external cervical os, which may also prolapse into the vaginal opening. However, the external cervical os is not visible on the mass, and the cervix is palpable in the vagina. Ultrasound examination reveals a linear, hypoechoic band within the uterine cavity, with the cervical canal dilated. The prolapsed material is a solid, hypoechoic mass.
3. Vaginal wall tumor
Clinically, this disease is generally painless, but may cause increased vaginal discharge. Gynecological examination may reveal a vaginal wall tumor (cystic or solid) with clear boundaries and may be mobile or fixed.
treat
Treatment principles
Treatment plans are individualized based on the severity of prolapse. For mild symptoms, conservative treatment is considered first, primarily using Traditional Chinese Medicine (TCM) for internal or external use, combined with acupuncture or placement of a pessary. Qi deficiency and sunken lower limbs are treated by tonifying the middle and replenishing Qi, raising Yang and lifting the sunken lower limbs. Kidney deficiency is treated by tonifying the kidneys, consolidating the prolapse, and replenishing Qi. For damp-heat in the lower limbs, the focus is on clearing damp-heat in the liver and gallbladder. For patients who fail conservative treatment or have severe symptoms, surgical treatment may be considered.
General treatment
Pelvic floor muscle exercises are a treatment for anterior vaginal wall prolapse. They are suitable for patients with mild cases of uterine prolapse and can also serve as an adjunct treatment before and after surgery for patients with more severe cases. Doctors will instruct patients to perform anal contraction exercises, forcefully contracting the pelvic floor muscles for 5-10 seconds and then relaxing, for 10-15 minutes at a time, two to three times daily. This method can increase the tone of the pelvic floor muscles.
Drug treatment
1. Oral administration of Chinese medicine
(1) Qi deficiency and sinking: Buzhong Yiqi Decoction with modifications. Commonly used Chinese medicines include ginseng, astragalus, white atractylodes, angelica, tangerine peel, cimicifuga, bupleurum, etc.
(2) Kidney deficiency: Dabuyuan decoction with modifications. Commonly used Chinese medicinal materials include ginseng, Chinese yam, Rehmannia root, Eucommia bark, Chinese angelica, and Cornus officinalis.
(3) Damp-heat descending: Longdan Xiedan Decoction with modifications. Commonly used Chinese herbs include Gentiana scabra, Scutellaria baicalensis, Gardenia jasminoides, Bupleurum chinense, Rehmannia glutinosa, Angelica sinensis, Alisma orientalis, Plantago asiatica, Akebia trifoliata, and Licorice root. Some believe that Longdan Xiegan Decoction combined with Shengxian Decoction is more suitable for yin tiao with damp-heat descending.
2. External washing with Chinese medicine
Yinting is combined with fumigation with traditional Chinese medicines that consolidate, astringe, elevate, and dissipate, demonstrating excellent clinical efficacy. Ancient texts compiled in the Chinese Pharmacopoeia rank the herbs used in Yinting external washes in descending order: alum, Cnidium monnieri, Gallnut, Schizonepeta tenuifolia, Prunus mume, Citrus aurantium, slaked lime, Glauber’s salt, Chinese angelica, Angelica dahurica, and Terminalia chebula. These herbs primarily aim to dry dampness, consolidate, and elevate the body.
Related drugs
Buzhong Yiqi Decoction, Dabuyuan Decoction, Longdan Xiedan Decoction
Surgical treatment
The following different surgical methods can be selected according to the patient’s age, degree of uterine prolapse, fertility requirements and overall health status.
1. Mann’s surgery
Repair of the anterior and posterior vaginal walls, shortening of the main ligaments, and partial cervical resection are suitable for younger patients with a long cervix who wish to preserve their fertility and have grade II or III uterine prolapse accompanied by anterior and posterior vaginal wall prolapse.
2. Vaginal hysterectomy and anterior and posterior vaginal wall repair
It is suitable for patients with grade II and III uterine prolapse accompanied by anterior and posterior vaginal wall prolapse, who are older and have no desire to have children.
3. Vaginal septum formation
It is suitable for the elderly and frail who cannot tolerate major surgery and do not need to preserve sexual function.
4. Uterine suspension
Surgery can be performed to shorten the round ligament, or various slings can be made from some biological materials to suspend the uterus and vagina.
Traditional Chinese Medicine treatment
It can also be combined with acupuncture treatment. The specific acupoint selection methods are as follows:
1. Qi deficiency syndrome
Select acupoints such as Baihui, Qihai, Weidao, Zusanli, Sanyinjiao, Pishu, Taichong, and Hegu. For patients with other symptoms, acupoints should be selected based on syndrome differentiation.
2. Kidney deficiency syndrome
Select Guanyuan, uterus, Zhaohai, Sanyinjiao, Shenshu, Mingmen, Taixi and other acupoints. For patients with other symptoms, acupoints should be selected based on syndrome differentiation.
Other treatments
1. Acupuncture treatment
According to Traditional Chinese Medicine (TCM), the uterus is closely connected to the Taiyin Spleen Meridian, the Shaoyin Kidney Meridian, the Ren Meridian, the Chong Meridian, the Du Meridian, and the Dai Meridian. Acupoints such as Guanyuan, Zhongji, Qihai, Uterus, Tituo, and Baihui are often selected for treatment. Currently, commonly used acupuncture treatments include electroacupuncture, moxibustion, acupoint injection, and catgut embedding.
(1) Electroacupuncture: Electroacupuncture refers to inserting acupuncture needles into acupoints to obtain Qi, and then passing a pulse current close to the human body’s bioelectricity. Through the continuous stimulation of acupoints by electroacupuncture, the frequency of Qi obtaining at the acupoints can be increased, thereby achieving a better therapeutic effect.
(2) Moxibustion: Moxibustion is a treatment method that uses moxa as the main burning material to burn and fumigate acupoints and meridians. It can stimulate the body’s positive energy and enhance disease resistance, while also having the effect of supporting yang and consolidating deficiency. The heat of moxibustion fire has the function of supporting yang, lifting sunken and consolidating deficiency, so it is suitable for patients with qi deficiency and kidney deficiency with yin erection. Moxibustion is often applied to the Baihui acupoint to raise yang and consolidate deficiency, and is most effective when used in combination with acupuncture.
(3) Acupuncture point injection: Acupuncture point injection, also known as water injection, involves injecting an appropriate amount of Chinese and Western medicine into appropriate acupuncture points. Through the dual stimulation of acupuncture and medication on the acupuncture points, the effect of treating the disease can be better achieved. It has a certain effect on uterine prolapse.
(4) Acupoint catgut embedding: Acupoint catgut embedding refers to embedding catgut into acupoints, using the catgut to continuously stimulate the acupoints to treat diseases. Commonly selected acupoints include Zusanli, Sanyinjiao, Tigong, Gongzi, Guanyuan, Zhongzha, and Changqiang. After the catgut is embedded in the acupoints, Buzhong Yiqi Pills or Longdan Xiegan Pills are taken according to the symptoms. Moxibustion can also be used in combination with the treatment.
2. Place a pessary
A uterine prolapse device is a device that helps maintain the uterus and vaginal wall within the vagina, preventing them from falling out. It comes in three shapes: trumpet, ring, and spherical. It is suitable for uterine prolapse and anterior and posterior vaginal prolapse. It should not be used in patients with severe uterine prolapse accompanied by pelvic floor muscle atrophy or pelvic inflammation. It should be discontinued during menstruation and pregnancy.
Treatment cycle
The treatment period for vaginal prolapse is generally 10 days, but there may be individual differences due to factors such as the severity of the disease, treatment plan, treatment timing, and personal constitution.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
The outcome and prognosis of vaginal prolapse are mainly related to the cause, severity of the disease, and whether the diagnosis and treatment are timely and appropriate.
Hazards
Although this disease is not fatal, it can cause urinary and reproductive system infections, leading to chronic pelvic pain, urinary incontinence, fecal incontinence, sexual dysfunction, etc. In severe cases, it can affect fertility and cause women to lose their ability to work, thereby affecting their quality of life.
Curative
With early and timely treatment, most patients have a good prognosis or even cure. If not treated in time, the disease will be prolonged and difficult to cure.
Cure rate
Most patients can be cured through treatment and conditioning.
Recurrent
During or after treatment, if you continue to lift heavy objects or overwork, it is easy to cause relapse.
daily
Overview
Good daily life management is conducive to better treatment effects, relieving or controlling symptoms and promoting recovery.
Psychological care
Keep a good mood and a cheerful spirit, avoid adverse mental stimulation and excessive emotional fluctuations; communicate more with doctors, understand the development of the disease and treatment measures, build confidence in treatment, and actively cooperate with treatment.
Medication care
Strictly follow the doctor’s instructions when taking medication, avoid stopping the medication or adjusting the dosage at will; if any adverse reaction occurs, inform the doctor in time to avoid delaying the condition.
Life Management
1. Live a regular life and the living environment should be quiet, spacious and comfortable.
2. Get adequate rest, avoid heavy physical labor, do not lift heavy objects, and avoid squatting for long periods of time.
3. Pay attention to the combination of work and rest. You can relax your body and mind and strengthen your physical fitness through meditation, yoga and other exercises combined with breathing methods.
4. Maintaining smooth bowel movements and strengthening pelvic floor muscle exercises can improve and alleviate the symptoms of stress urinary incontinence.
Disease monitoring
After surgical treatment, patients should pay attention to the characteristics of vaginal discharge.
Follow-up Instructions
It is usually recommended that patients who have undergone surgical treatment return to the outpatient clinic to review the healing of the incision one month after discharge.
diet
Dietary adjustment
A scientific and reasonable diet can ensure the normal functioning of the body, help control the disease, maintain the treatment effect, and promote recovery from the disease.
Dietary recommendations
1. Qi deficiency and sinking
The diet should be warm, with fine, soft foods as the main focus. Eat more yam, potato, radish, corn, etc. Avoid taking foods that are too hot. You can make porridge with yam, poria cocos, and polished rice in appropriate amounts.
2. Kidney Qi deficiency
A light diet should be adopted, with more warming foods like lamb and leeks, and less cold foods like cucumber, lotus root, and pear. A recovery soup can be taken: Chinese yam, walnut kernels, lean lamb, lamb spine, glutinous rice, and scallion whites in appropriate amounts. Boil the lamb spine for half an hour, then add the lamb and bring to a boil. Remove any scum and add ginger, Sichuan peppercorns, cooking wine, peppercorns, star anise, and salt.
3. Damp-heat
The diet should be light. It is recommended to eat foods that nourish yin, clear heat and eliminate dampness, such as winter melon, apple, mung bean, red bean, coix seed, lotus root, etc. Mung bean porridge and coix seed porridge can be eaten appropriately.
Dietary taboos
1. Avoid eating raw, cold, greasy, spicy and irritating foods.
2. No smoking or drinking.
prevention
Preventive measures
The prevention of vaginal prolapse mainly focuses on the prevention and treatment of the cause, including daily and postpartum protective measures.
1. Promote late marriage and late childbearing to prevent excessive and dense births.
2. Pay attention to personal hygiene and keep the vulva clean.
3. Drink more water, eat less spicy and irritating foods, and actively prevent and treat constipation.
4. Handle the labor process correctly to avoid it being too long.
5. Reduce birth injuries and repair them promptly if any occur.
6. Avoid participating in heavy physical labor too early after delivery. You can do health exercises after delivery to help the pelvic floor muscles and fascia tension recover as soon as possible.
7. Actively treat chronic cough or bronchitis and quit smoking.
8. Control your weight.