Pelvic Support Problems

The pelvic organs include the vagina, uterus, bladder, urethra, and rectum. These organs are held in place by muscles of the pelvic floor. Layers of connective tissue also give support. Pelvic organ prolapse (POP) occurs when tissue and muscles can no longer support the pelvic organs and they drop down.

Pelvic Support Problems

The pelvic organs include the vagina, uterus, bladder, urethra, and rectum. These organs are held in place by muscles of the pelvic floor. Layers of connective tissue also give support. Pelvic organ prolapse (POP) occurs when tissue and muscles can no longer support the pelvic organs and they drop down.

Cause of Pelvic Organ Prolapse

The main cause of POP is pregnancy and vaginal childbirth, which can weaken muscles of the pelvic floor. Other causes of pelvic support problems include menopause, aging, and repeated heavy lifting. Conditions that create pressure on the abdomen can cause POP, including being overweight or obese; being constipated and straining to have bowel movements; and chronic coughing caused by smoking, asthma, or other medical conditions. POP can occur at any age, but most women who develop symptoms do so after menopause.

Symptoms can come on gradually and may not be noticed at first. Many women have no symptoms and do not know they have a prolapse. An obstetrician–gynecologist (ob-gyn) or other health care professional may discover a prolapse during a physical exam.

When POP is mild, sometimes a bulge can be felt inside the vagina. For severe cases of POP, organs may push out of the vaginal opening.

Women with symptoms may experience the following:

  • Feeling of pelvic pressure or fullness
  • Organs bulging out of the vagina
  • Leakage of urine (urinary incontinence)
  • Difficulty completely emptying the bladder
  • Problems having a bowel movement
  • Lower back pain
  • Problems with inserting tampons or applicators

There are several types of prolapse that have different names depending on the part of the body that has dropped:

  • Cystocele—bladder
  • Enterocele—small intestine
  • Rectocele—rectum
  • Uterine prolapse—uterus
  • Vaginal vault prolapse—top of the vagina

Frequently Asked Questions

Many women do not need treatment. At regular checkups your ob-gyn or other health care professional will keep track of the problem. If symptoms become bothersome, treatment may be needed. Treatment decisions are based on the following factors:

  • Age
  • Desire for future children
  • Sexual activity
  • Severity of symptoms
  • Degree of prolapse
  • Other health problems

No form of treatment is guaranteed to solve the problem, but the chances of getting some degree of relief are good.

Surgery may be an option for women who have not found relief with nonsurgical treatments. Surgery may relieve some, but not all, symptoms. In general, there are two types of surgery: 1) surgery to repair the pelvic floor and 2) surgery to shorten, narrow, or close off the vagina.

Surgery to repair the pelvic floor helps restore the organs so they are closer to their original position. Surgery that shortens or closes off the vagina creates support for prolapsed organs. Vaginal intercourse is not possible after this procedure. Women who choose this type of surgery usually have other serious health problems and do not desire future intercourse.

Recovery time varies depending on the type of surgery. You usually need to take a few weeks off from work. For the first few weeks, you should avoid vigorous exercise, lifting, and straining. You also should avoid sex for several weeks after surgery.

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