Pelvic Support Problems (Pelvic Organ Prolapse)
Pelvic support problems at a glance
- Pelvic support problems are issues that occur when the muscles and fascia (connective tissue) in the pelvic floor can no longer support the organs of the pelvis (bladder, urethra, small intestine, rectum, vagina, cervix, and uterus).
- When pelvic support problems develop, one or more of the organs of the pelvis bulges or descends into or outside the vaginal canal or anus, a condition known as pelvic organ prolapse.
- Tearing or stretching of the pelvic floor muscles during pregnancy and childbirth is the most common cause of pelvic organ prolapse. Aging, chronic coughing, constipation and obesity can also cause pelvic support problems.
- Symptoms of pelvic support problems vary, but may include urinary problems, constipation, painful intercourse, and/or a feeling of fullness or pressure in the lower abdomen.
- Treatment for pelvic organ prolapse depends on the severity of the symptoms, but may include special exercises, inserting a pessary to support the drooping organs, and in some cases, surgery.
Symptoms of pelvic support problems
For some women, pelvic support problems cause no symptoms. For others, common symptoms of pelvic organ prolapse include:
- Frequent urge to urinate and/or leakage
- Constipation
- Lower back pain
- Pain or difficulty with intercourse
- A feeling of pulling or aching in the pelvis
- Vaginal spotting or bleeding
- A bulge in the vagina
- Pelvic pressure that worsens when standing, lifting, or coughing
The symptoms of pelvic organ prolapse depend on which organ is affected. Sometimes, more than one organ descends at the same time. There are several types of pelvic organ prolapse, including:
- Cystocele – the bladder drops from its normal location, putting pressure on the vagina.
- Urethrocele – the urethra drops from its normal location; this often occurs at the same time as a cystocele.
- Uterine prolapse – the uterus descends into the vagina, which causes a sense of pulling in the pelvis, or tissue to protrude from the vagina.
- Vaginal vault prolapse – the top of the vagina descends; this often occurs after a hysterectomy, and can cause incontinence (involuntary urination), pelvic heaviness, or a mass to protrude from the vagina.
- Enterocele – the small intestine bulges into the back wall of the vagina; this often occurs at the same time as a vaginal vault prolapse.
- Rectocele – the rectum presses against or bulges into the back wall of the vagina, which can cause a sense of rectal pressure, difficulty having bowel movements, and a feeling that the rectum has not completely emptied after a bowel movement.
Causes
Pelvic organ prolapse is most often caused by pregnancy and childbirth. Women who delivered their child(ren) vaginally are more likely to experience pelvic support problems than women who have had a cesarean section.
Pelvic support problems can also be caused by:
- Aging
- Menopause
- Pelvic surgery and/or hysterectomy
- Increased abdominal pressure from chronic coughing, being overweight or obese, or straining during bowel movements/constipation
- Genetic factors – women of Asian or Hispanic descent are more likely than other women to develop pelvic organ prolapse; women whose mothers experienced pelvic organ prolapse are also more likely to develop the problem