The pelvic floor is comprised of a group of muscles, tissues, and ligaments that form the base of the pelvis and support the pelvic organs (uterus, bladder, ureters, urethra and rectum). If any of the pelvic muscles and ligaments become weak or damaged the pelvic organs can shift, dropping below their normal positions in the pelvis. This condition is known as pelvic organ prolapse (or pelvic floor prolapse).
Types of Pelvic Organ Prolapse
Although the term "pelvic organ prolapse" refers to a shift in any pelvic organ, the type of prolapse is identified by the organ that has descended. Identifying which organ has shifted will determine treatment. Types of pelvic organ prolapse include:
Cystocele, also known as prolapsed bladder, occurs when the bladder drops into the vagina and commonly occurs when childbirth, severe coughing, chronic constipation, menopause, heavy lifting, or obesity weaken the pelvic muscles. The vaginal walls can also be weakened during and after menopause by low levels of estrogen, a hormone that the body uses to make collagen (a protein that helps keep muscle stretchy).
Rectocele occurs when the thin wall of tissue that separates the rectum from the vagina weakens, forcing the rectum to protrude into the vagina. Also known as posterior prolapse, rectocele is caused by the same factors as cystocele.
Uterine prolapse is when the pelvic floor is unable to support the uterus, causing it to slip into or protrude out of the vagina. The main causes uterine prolapse are pregnancy and childbirth—particularly if the baby is large or has trouble emerging from the vaginal canal. Menopause-induced hormonal and structural changes to the vagina can also trigger the condition.
Enterocele refers to the type of prolapse caused when the small intestine pushes its way into the top part of the vagina. Childbirth, severe coughing, chronic constipation, being overweight, or heavy lifting can all increase pressure on the pelvic floor, causing weakness or tearing.
Symptoms of Pelvic Organ Prolapse
Many women with mild forms of pelvic organ prolapse (pelvic floor prolapse) experience no symptoms. Symptoms of moderate to severe prolapse can include:
- Discomfort in the vagina, especially after long periods of standing
- Increased pressure or pain in the vagina when coughing or lifting heavy objects
- A lump of tissue protruding through the opening of the vagina
- Inability to completely empty the bladder
- Recurrent urinary tract infections
- Pain during intercourse
- Incontinence
- Lower back or abdominal pain
Diagnosis of Pelvic Organ Prolapse
Diagnosing pelvic organ prolapse starts with a pelvic exam, typically with a urologist, which helps a physician establish type of prolapse and severity. Patients will also be asked about their medical history, including recent physical activity, current medical conditions, and the number of children they've had.
While diagnosis may only require a physical exam, if the prolapse is significant, the doctor may also do a bladder function test to determine how well the bladder stores and empties urine. Imaging exams—CT scan, MRI, and ultrasound—may also be conducted and can show what is occurring within the pelvic floor. A pelvic floor strength test, which requires the patient to hold a pelvic floor contraction until her muscles tire, can determine whether the pelvic organs are properly supported.
Treatment of Pelvic Organ Prolapse
Pelvic organ prolapse treatment depends on the severity and type of prolapse. If the prolapse is mild and does not cause any functional problems with the urinary or reproductive systems, muscle strengthening exercises (Kegels) and medications may be prescribed. For more severe cases, surgical treatment may be the best option. In some cases, pelvic organ prolapse is associated with a condition called Relaxed Vaginal Outlet, which can sometimes require surgical treatment.
References:
Badash, M. (2012). Uterine prolapse. Conditions and Procedures in Brief, 1-3.
McCoy, K. (2012). Vaginal prolapse. Conditions and Procedures in Brief, 1-3.
