Pelvic Organ Prolapse
The pelvic organs include the vagina, cervix, uterus, bladder, urethra, and the small intestines and rectum. The pelvic organs are held in place by muscles of the pelvic floor. Layers of connective tissue called fascia also provide support.
Pelvic organ prolapse occurs when the fascia and muscles can no longer support the pelvic organs. These supporting muscles and fascia may become torn or stretched, or they may weaken because of aging. As a result, the organs that they support can drop downward. Sometimes, a bulge can be felt inside the vagina. In severe cases, organs may protrude from the vaginal opening.
Many women have no symptoms and are not bothered by their pelvic organ prolapse. A woman may only have felt a bulge of tissue inside her vagina or her health care provider may have noticed it during a physical exam. The symptoms of those who do have problems can range from mild to severe. Listed are common symptoms of pelvic organ prolapse:
- Feeling of pelvic heaviness or fullness
- Bulge in the vagina
- Organs bulging out of the vagina
- Pulling or aching feeling or a feeling of pressure in the lower abdomen or pelvis
- Lower back pain
- Leakage of urine (urinary incontinence) or problems having a bowel movement
- Needing to push organs back up into the vagina to empty the bladder or have a bowel movement
- Sexual difficulties
- Problems with inserting tampons or applicators
- Pelvic pressure that gets worse with standing, lifting, or coughing or as the day goes on
Pelvic organ prolapse is caused by injury to the muscles or supporting tissue of the pelvic floor. The main cause of this type of injury is having had children. Women who have had a vaginal delivery have a slightly increased risk of pelvic support problems than those who have had acesarean delivery.
Other causes of pelvic support problems are prior pelvic surgery, menopause, aging, and intense physical activity. Also, factors that add more pressure on the abdomen can cause pelvic organ prolapse, such as being overweight or obese, being constipated and straining to have a bowel movement, and chronic coughing. Heredity is another important factor. This problem runs in families.
Types of Pelvic Support Problems
There are many types of prolapse:
- Uterine prolapse—uterus
- Vaginal vault—top of the vagina
- Enterocele—small intestine
Kegel exercises tone the pelvic muscles. They strengthen the muscles that surround the openings of the urethra, vagina, and rectum. Here is how they are done:
- Squeeze the muscles that you use to stop the flow of urine. This contraction pulls the vagina and rectum up and back.
- Hold for up to 10 seconds, then release.
- Do 50 contractions a day for 4–6 weeks.
- Make sure you are not squeezing your stomach, thigh, or buttocks muscles. You also should avoid holding your breath as you do these exercises
Changes in diet and lifestyle may be helpful in relieving specific symptoms. If incontinence is a problem, limiting fluid intake, including drinks that contain caffeine (a diuretic), may be helpful. Bladder training (in which you empty your bladder at scheduled times) also may be useful for women with incontinence. Women with bowel problems may find that increasing the amount of fiber in their diets prevents constipation and straining during bowel movements. Sometimes a laxativeor medication that softens stools is prescribed. If a woman is overweight or obese, weight loss can help improve her overall health and possibly her prolapse symptoms.
Exercises called Kegel exercises, or pelvic floor exercises, are used to strengthen the muscles that surround the openings of the urethra, vagina, and rectum (see box “Kegel Exercises”). Doing these exercises regularly may improve incontinence. A health care provider can help a woman be sure she is doing these exercises correctly.
A pessary is a device that is inserted into the vagina to support the pelvic organs. Many women find relief of their symptoms with pessary use.
Pessaries are available in many shapes and sizes. They can be used for short-term or long-term treatment. Pessary choice is based on a woman’s symptoms and the type of prolapse. They can be fitted in most women with prolapse, regardless of type, and some can be used by women who are sexually active.
A health care provider can help find the right pessary that fits comfortably. Some pessaries are designed to be removed, cleaned, and reinserted by the user; for others, a woman must see her health care provider on a regular basis.
Some pelvic support problems may be corrected by surgery to restore the normal depth and function of the vagina. The surgery can be done through the vagina or abdomen based on the type of support problem. Surgery may relieve some, but not all, of the symptoms caused by pelvic organ prolapse.
Women who want to have children should consider having them before they have surgery for pelvic support problems. If a woman with a pelvic support problem does become pregnant, she can discuss with her health care provider the best way to give birth and prevent future prolapse.
Many women with prolapse also have problems with urine leakage. Some women begin to have this problem after having surgery to correct prolapse. During surgery, doctors now often include a procedure to prevent or improve incontinence.
Prolapse can recur after surgery. The factors that caused a woman to have prolapse in the first place can cause it to occur again.
Many women have some degree of pelvic organ prolapse, although not all women with this problem have symptoms. If you have symptoms that bother you, talk to your health care provider. The right diagnosis and treatment can bring relief.