What is the difference between anterior wall bulge and uterine prolapse?

Anterior wall bulge and uterine prolapse are both pelvic floor dysfunction diseases, but the location of the lesions and clinical manifestations are different. Anterior wall bulge mainly refers to the bulging of the front wall of the vagina, while uterine prolapse refers to the descent of the uterus from its normal position along the vagina. Both may be caused by pelvic floor muscle relaxation, childbirth injuries, long-term increased abdominal pressure and other factors, and need to be diagnosed clearly through gynecological examination.

1. Diseased area

Anterior vaginal wall bulge is a hernia formed by the bladder or urethra protruding into the anterior vaginal wall, often accompanied by stress urinary incontinence. Uterine prolapse is a downward shift of the cervix or uterine body. In severe cases, it prolapses out of the vaginal opening, and may be combined with rectocele or posterior vaginal wall bulge.

2. Symptoms

Prolapse of the anterior vaginal wall is often manifested as a vaginal introitus swelling, difficulty urinating, or frequent urination. Typical symptoms of uterine prolapse are a sinking feeling and lumbosacral pain. Severe prolapse may reveal cervical erosion or ulcers. Both symptoms may worsen when standing for a long time or coughing.

3. Pathogenesis

Anterior vaginal wall bulge is related to vesicovaginal fascia defect and is common in patients with multiple vaginal deliveries. Uterine prolapse is mainly caused by the relaxation of supporting structures such as cardinal ligaments and sacral ligaments. The decline in estrogen levels after menopause will accelerate the progression of the disease.

4. Diagnostic methods

During the gynecological examination, breath-holding and forceful movements are required to assess the degree of prolapse. The bulge of the anterior vaginal wall is measured using the Aa/Ba points in the POP-Q indexing method, and the prolapse of the uterus is judged by the position of the C point. Ultrasound or MRI can help identify other pelvic floor hernias.

5. Treatment differences

Kegel exercises can be performed for mild anterior wall bulge, while anterior vaginal wall repair surgery is required for moderate to severe cases. For uterine prolapse of I-II degrees, a pessary can be used. For grades III and above, uterine sling or resection is recommended. Both need to avoid behaviors that increase abdominal pressure, such as heavy lifting and chronic coughing.

Daily pelvic floor muscle exercises should be strengthened, such as anal contraction exercises every day. Obese people need to control their weight, and those with constipation should adjust their dietary fiber intake. When urination and defecation difficulties occur or the quality of life is affected, you should promptly go to the gynecology department or pelvic floor rehabilitation center to avoid repeated infections of the urinary system caused by long-term prolapse.