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:
- Feeling of 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 or 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?
There are several types of prolapse:
- 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 position into the vagina.
- Urethrocele — this occurs when the urethra bulges into the vagina. It often occurs together with a cystocele.
- Enterocele — the small bowel presses on the back wall of the vagina, creating a bulge. An enterocele often occurs together 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 also may be checked.
What are some nonsurgical ways to obtain symptom relief?
- Lifestyle changes — if incontinence is a problem, limiting fluid intake, including drinks containing caffeine (a diuretic), can help. Women with bowel problems may find that increasing the amount of fibre in their diet prevents constipation and straining during bowel movements. A laxative or a stool softener is sometimes prescribed.
- Bladder training — in this form of treatment you empty your bladder at scheduled times. It may be helpful for women with incontinence.
- Weight loss — if you are overweight or obese, losing weight can help improve your overall health and possibly your prolapse symptoms.
- Kegel exercises — these strengthen the muscles that surround the openings of the urethra, vagina and rectum. Doing them regularly can improve incontinence.
- Pessaries — a pessary is a device inserted into the vagina to support the pelvic organs. Your gynecologist can help find a pessary that fits well and is comfortable for you.
What are Kegel exercises?
- Squeeze the muscles you would use to stop the flow of urine. This contraction pulls the vagina and rectum up and back.
- Hold for up to 10 seconds, then release.
- Do 50 exercises a day for 4–6 weeks.
Make sure you are not tightening your stomach, thigh or buttock muscles. You should also avoid holding your breath while doing these exercises.
Can surgery correct pelvic support problems?
Some pelvic support problems can be corrected with surgery to restore the normal depth and function of the vagina. Symptoms such as back pain, pelvic pressure and painful intercourse may not be relieved by surgery to repair prolapse. The chances of reducing the problems are, however, quite high. Prolapse can recur after the operation: the factors that caused a woman's prolapse in the first place may cause it again.