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Jodi Bollenbacher, PA-C
Pelvic Pain Center
What are pelvic support problems?
The pelvic organs include the vagina, cervix, uterus, bladder, urethra, 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. These supporting muscles and fascia may become torn or stretched, or they may weaken because of aging. Problems with pelvic support often are associated with pelvic organ prolapse. In this condition, the fascia and muscles can no longer support the pelvic organs. As a result, the organs that they support can drop downward.
What are the symptoms of pelvic organ prolapse?
Many women have no symptoms and are not bothered by their pelvic organ prolapse. The symptoms of those who do have problems can range from mild to severe. Listed are common symptoms of pelvic organ prolapse:
- 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 as the day goes on
What causes pelvic organ prolapse?
The main cause of pelvic organ prolapse 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 a cesarean delivery.
Other causes of pelvic support problems include the following:
- Prior pelvic surgery
- Menopause
- Aging
- Intense physical activity
- Factors that increase pressure in the abdomen, such as being overweight or obese, constipation and straining to have a bowel movement and chronic coughing
- Genetic factors
What are the types of pelvic organ prolapse?
The different types of prolapse are:
- Uterine prolapse – The uterus drops into the vagina
- Vaginal vault prolapse – The top of the vagina – the “vaginal vault” – drops. This problem occurs most often in women who have had a hysterectomy.
- Cystocele – The bladder drops from its normal place into the vagina
- Urethrocele – A urethrocele happens when the urethra bulges into the vagina. It often occurs with a cystocele.
- Enterocele – The small intestine pushes against the back wall of the vagina, creating a bulge. Enteroceles often occurs with vaginal vault prolapse.
- Rectocele – The rectum bulges into or out of the vagina.
What exams are performed to help diagnose pelvic support problems?
Your health care provider will do a thorough exam, including a vaginal and rectal exam. You may be examined while lying down or while standing. You may be asked to strain or cough during the exam to see if you leak urine. How completely your bladder empties may also be checked.
What are some treatment options?
There are numerous options for treatment of symptoms of pelvic support problems. These may include lifestyle changes, bladder training, weight loss, Kegel exercises, pessaries and even surgical interventions. If you are suffering from any of the above symptoms, you should talk with your doctor to explore the treatment option best for you.