What is pelvic prolapse?

Broad bands of ligaments support the uterus and other organs in the pelvis, but sometimes these ligaments can weaken and stretch, or become damaged or severed during surgery. The loss of structural support causes the organs to move down from their usual anatomical positions. The uterus, bladder, or rectum can drift down into the vagina. Physicians refer to this condition as pelvic prolapse.

Uterine, bladder, and rectum prolapse can happen after a woman has a baby. Women who have multiple vaginal births are at higher risk for developing these conditions, especially after menopause. Pelvic surgery can also increase the risk for prolapse, although Cesarean sections (c-section) are less strongly linked to prolapse than vaginal deliveries.

The prolapsed organs affect different parts of the vagina, depending on the location of that organ. Prolapse of the bladder, or the tube that brings urine to the outside, known as the urethra, presses against the front part of the vaginal wall. A prolapsed rectum presses against the back of the vaginal wall. During uterine prolapse, the uterus drops down into the vagina.

Causes

Uterine, bladder, and rectum prolapse are more likely after a woman goes through menopause. Estrogen increases the level of collagen, a protein that promotes strength and elasticity in ligaments. Estrogen levels drop during and after menopause, causing ligaments to weaken and become unable to hold organs in their correct anatomical locations.

Other conditions can increase the risk for prolapse of the uterus, bladder, or rectum. Obesity puts long-term, excess pressure on the abdomen and the organs inside it. Smoking and lung disorders cause chronic coughing. Muscular dystrophy and other diseases of the spinal cord can cause paralysis of the muscles in the pelvis.

Symptoms

Symptoms of uterine prolapse include tissue protruding from the vagina, a sensation of heaviness or pulling in the abdomen, and trouble with bowel movements. Women may also have a low backache or urinary problems, such as leakage and retention. Some women feel as if they are sitting on a small ball or as if something is falling out of their vagina.

Bladder prolapse causes symptoms such as fullness or pressure in the pelvis especially after standing for a long time, discomfort during coughing or straining, and feeling as if one has not emptied her bladder completely. Pain or leaking during sexual intercourse may occur. Rectal prolapse causes symptoms such as feeling a bulge or the appearance of a reddish-colored mass that appears just outside the anus.

Treatment

You can treat a mild pelvic prolapse at home by losing weight, not lifting heavy objects, and quitting smoking. You can also practice Kegel exercises, which contract and strengthen the muscles of the pelvic floor. Sometimes surgery is required. A vaginal pessary helps those who are not good candidates for surgery; inserting this device into the vagina helps support the pelvic floor.