Prolapse/Pelvic Floor Weakness

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Pelvic Pressure May Indicate 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.

Overview

What is Prolapse?

Pelvic organ prolapse or pelvic floor weakness is a hernia of the pelvic organs to or through the vaginal opening. All the 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.

Types of pelvic organ prolapse/pelvic floor weakness:

Bladder (cystocele): A hernia-like disorder that 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): A hernia-like disorder in which the wall between the rectum and the vagina weakens, causing the front wall of the rectum to push into the vagina
Small bowel (enterocele): A hernia-like disorder, occurring in women who have had hysterectomies, in which the small bowel protrudes into the top of the vagina
Uterus (uterine prolapse): A condition that occurs when the uterus droops into the vagina and starts to drop through the vaginal opening

Symptoms

What are the symptoms of Prolapse?

You may experience the following symptoms:

Constant heaviness
Increased pressure in the pelvis
Feeling or seeing a bulge coming from your vagina
Painful intercourse (dyspareunia)
Recurrent urinary tract infections
Difficulty emptying the bowel and/or bladder
Constipation
Urinary stress incontinence
Pain that increases during long periods of standing

Cause

What causes Prolapse?

In addition to childbirth, risk factors for the development of this condition include a family history of the condition, obesity, advancing age, prior hysterectomy, and conditions that chronically increase intra-abdominal pressure, such as asthma or constipation.

Diagnosis

How is Prolapse diagnosed?

What to know before your visit MidLantic Urology in Philadelphia and surrounding counties:

During your visit, your doctor will ask you questions regarding your medical history and will perform an exam with focused attention to the abdomen and genitalia.

Other tests that may be performed during or after your visit:

Urinalysis: This test evaluates for any blood in the urine or infection.
Post-void residual: The physician will often ask you to void and then check to make sure you are emptying your bladder.
Cystoscopy: This is a procedure performed in the office where the physician inserts a small scope into the urethra/bladder

Treatment

How is Prolapse treated?

NON-SURGICAL TREATMENT

Pelvic floor muscle exercises (i.e., Kegel exercises)

Biofeedback
Pelvic floor stimulation
Pessaries: A medical device inserted into the vagina used to provide structural support
Activity modification: The physician may recommend activity modification such as avoiding heavy lifting or straining.
Estrogen replacement therapy: Estrogen helps strengthen and maintain muscles in the vagina.

SURGICAL TREATMENT

Surgery to support the uterus or vagina. During surgery, your doctor may use your own body tissue or synthetic mesh to help repair the prolapse and build pelvic floor support. This type of surgery is recommended for sexually active women with serious prolapse of the vagina or uterus. Surgery for prolapse can be done through your vagina or abdomen. Your doctor may use synthetic mesh to repair the prolapse through the abdomen. But, because of safety issues, mesh is no longer used to repair the prolapse through the vagina.
Surgery to close the vagina. This surgery treats prolapse by closing the vaginal opening. This can be a good option for women who do not plan to have or who no longer have vaginal intercourse.