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Pelvic Prolapse
Weak muscles at the floor of the pelvis can cause a woman’s bladder, uterus, or other organs to drop into the vagina. Learn why and how prolapse can be treated.
What is Pelvic Prolapse?
Pelvic prolapse or pelvic floor weakness is a hernia of the pelvic organs. It may be noticeable at your vaginal opening. Your pelvic organs (bladder, uterus, and rectum) are supported by a “hammock” of muscles and ligaments. When these muscles are weakened, the bladder, uterus, or rectum can bulge or “drop” into the vagina.
Here are the various types of pelvic organ prolapse/pelvic floor weakness:
- Bladder (cystocele): occurs when the wall between the bladder and the vagina weakens, causing the back wall of the bladder to bulge into the vagina.
- Rectum (rectocele): the wall between the rectum and the vagina weakens, causing the front wall of the rectum to push into the vagina.
- Small bowel (enterocele): occurs in women who have had hysterectomies, in which the small bowel protrudes into the top of the vagina.
- Uterus (uterine prolapse): occurs when the uterus drops into the vagina and starts to drop through the vaginal opening.
Symptoms
These symptoms are common:
- Recurrent urinary tract infections
- Urinary urgency and frequency
- Feeling or seeing a bulge coming from your vagina
- Painful intercourse (dyspareunia)
- Difficulty emptying the bowel and/or bladder
- Constipation
- Increased pressure in the pelvis
- Lower back or pelvic pain
What causes Pelvic Prolapse?
Childbirth, especially vaginal delivery, is a key contributor to this condition. Other risk factors include a family history of the condition, obesity, advancing age, hysterectomy, and conditions that increase intra-abdominal pressure, such as asthma or constipation.
How is Pelvic Prolapse diagnosed?
During your visit, your doctor will ask about your medical history and perform an exam focused on the abdomen and genitalia.
Other tests may include:
- Urinalysis: This test looks for any blood in the urine or infection.
- Post-void residual: You’ll be asked to urinate, then checked to make sure are emptying your bladder.
- Cystoscopy: Your physician inserts a small scope into the urethra/bladder.
- Urodynamic testing: In cases where there is urine retention or severe urgency, this test is used to measure your bladder function. A catheter is inserted into your bladder to monitor bladder pressure and activity.
How is Pelvic Prolapse treated?
NON-SURGICAL TREATMENTS
- Pelvic floor muscle exercises (i.e., Kegel exercises) to strengthen these muscles.
- Pessaries: A medical device inserted into the vagina used to provide structural support.
- Activity modification: Your physician may recommend activity modification such as avoiding heavy lifting or straining.
SURGICAL TREATMENTS
- For sexually active women a vaginal surgery can be performed using their own vaginal tissue to rebuild pelvic floor support. Often, a more robust operation performed robotically through the abdomen is offered to support the vagina to the sacrum (tail bone) using synthetic mesh. Vaginal mesh procedures are no longer performed due to safety concerns
- For women who are not sexually active or who are high surgical risk (due to age or medical history) a simple surgery to close the vaginal opening can be performed.
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