Pelvic Prolapse

The pelvic floor is a group of muscles and ligaments that support a woman’s uterus, bladder, bowel and other pelvic organs. When the pelvic floor weakens and causes pelvic prolapse, the organs can sometimes slip down far enough to create a bulge in your vagina or, in some cases, protrude from it.

Weakening of the pelvic floor can be caused by:

• Aging.
• Being overweight.
• Chronic coughing.
• Decreased estrogen levels.
• Heavy lifting.
• Loss of muscle tone.
• Pregnancy.
• Radiation.
• Straining during bowel movements.
• Surgery.
• Vaginal childbirth.

Types of Pelvic Prolapse

There are different types of pelvic prolapse, depending on the organs affected. It’s common for women to experience more than one type of pelvic prolapse.

Types of pelvic prolapse include:

• Anterior prolapse – Also known as a cystocele or a prolapsed bladder, affects your bladder.
• Posterior prolapse – Also called a rectocele, affects your rectum.
• Uterine prolapse – Involves your uterus.
• Small bowel prolapse – Also called enterocele, affects your small intestine.

Prevention

Some of the causes of pelvic prolapse are unavoidable, but there are things you can do to improve your pelvic health and reduce your risk of developing the condition. Steps you can take to lower risk include:

• Prevent constipation. If you have trouble with regular bowel movements, you can ease constipation by using gentle laxatives or stool softeners. High-fiber foods can also help prevent and treat constipation. If you experience severe or chronic constipation, talk to your doctor.
• Lift properly. Use your legs instead of your waist or back while lifting, and avoid lifting things that are too heavy.
• Control coughing. Get treatment for a long-lasting cough.
• Maintain a healthy weight. Carrying around extra weight puts unnecessary stress on your body, including your pelvic floor muscles. Eating a nutritious, well-balanced diet and getting regular exercise can help.

You can also help prevent pelvic prolapse by strengthening your pelvic floor muscles — the muscles you use to stop urine flow — with Kegel exercises:

• Contract (tighten) your pelvic floor muscles and hold for five seconds. If five seconds is too difficult, start with two or three seconds. The goal is to work up to holding the contraction for 10 seconds at a time.
• Relax the muscles for five seconds.
• Repeat the tightening and releasing 10 times. Do the exercise three times daily.

Symptoms

With mild cases of pelvic prolapse, you may not experience any symptoms. Women with symptoms may notice they feel worse when they’re sitting or standing as opposed to lying down, and that their symptoms tend to get worse as the day goes on.

Symptoms can include:

• Pelvic discomfort – Pressure in your pelvis or vagina, pain when you cough or have a bowel movement, lower back pain or pain during sex.
• Bladder issues – Leaking urine when you cough or exercise, feeling like your bladder is not empty after urinating or reoccurring bladder infections.
• Bowel issues – Pressure in your rectum, leaking stool, difficulty having a bowel movement or feeling like your rectum isn’t empty after a bowel movement.

Diagnosis

Most of the time, your doctor can determine whether you have pelvic prolapse by talking to you about your symptoms and performing a pelvic exam to check for a bulge of tissue in your vagina. If your doctor detects something during the pelvic exam, he or she may perform additional testing to determine the extent of your prolapse. Your doctor may use imaging exams, such as magnetic resonance imaging (MRI) or ultrasound, or tests to see how completely your bladder or rectum empties. To further investigate bladder problems, your doctor may use cystoscopy to view your urinary tract using a thin tube with a light and camera.

Treatment

If you’re not experiencing symptoms, you probably don’t need treatment. However, if symptoms are interfering with your well-being, there are a variety of treatments available. Your doctor will help you choose what’s right for you.

Nonsurgical Treatment

Nonsurgical treatments include:

• Estrogen therapy. A drop in estrogen levels can weaken pelvic muscles, so increasing your estrogen levels can help strengthen your pelvic floor muscles. Talk to your doctor to find out if estrogen therapy is a good option for you.
• Physical therapy. Through the use of biofeedback, a physical therapist can confirm whether you’re performing Kegel exercises properly. Sensors are placed on your skin to measure the strength of each contraction as you perform the exercises, and the information is displayed on a monitor. Your physical therapist can help make adjustments to ensure you’re getting the best results.
• Vaginal pessary. Your doctor can fit you with a special device — made of silicone, plastic or rubber — that fits inside your vagina to support the bulging tissue and keep your uterus in place. It can be used as short-term or permanent treatment.

Surgical Treatment

Doctors use prolapse surgery to repair bulging tissue — surgery is only necessary if the condition is causing you discomfort. If you plan to become pregnant, it may be best to delay surgery for pelvic prolapse. Your doctor will help you determine the right choice for you.

Pelvic prolapse surgery can be performed through your vagina or abdomen. Sometimes minimally invasive laparoscopic surgery is an option, which uses smaller abdominal incisions and specialized surgical instruments. Surgery may involve grafting tissue or synthetic material (mesh) onto the weakened pelvic floor structures to support your pelvic organs.

There are different surgical approaches for each type of prolapse:

• Posterior prolapse surgery. Your doctor removes excess tissue and secures the connective tissue between your vagina and rectum to help keep your rectum in its proper position.
• Anterior prolapse surgery. Your doctor removes excess tissue and secures the connective tissue between your bladder and vagina to keep your bladder in its proper position. Your doctor may use a bladder neck suspension or sling to support your urethra if urinary incontinence is a problem for you.
• Uterine prolapse surgery. There are procedures that can be used to correct the condition without removing the uterus. The type of surgery will depend on the severity of the prolapse, your health and other considerations. If you don’t plan to become pregnant, your doctor may recommend a hysterectomy to correct uterine prolapse.
• Small bowel prolapse surgery. In women who’ve had a hysterectomy, this type of prolapse is also called vaginal vault prolapse and may involve the bladder, rectum or small bowel. When performing the surgery vaginally, your doctor will use the ligaments that support your uterus to correct the problem. When performing the surgery through your abdomen, your doctor will attach your vagina to your tailbone and may use synthetic mesh to help support vaginal tissue.