OB/GYN > About Us > Gynecologic Care > Pelvic Support Problems

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.

There are many 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 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 occur with vaginal vault prolapse.
  • Rectocele—The rectum bulges into or out of the vagina.

Symptoms

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, and include:

  • 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 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

Causes

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 include:

  • 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

Diagnosis

We 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.

Treatment

Nonsurgical treatment options include:

  • Lifestyle changes
  • Bladder training
  • Weight loss
  • Kegel exercises
  • Pessaries—A pessary is a device inserted into the vagina to support the pelvic organs.

Some pelvic support problems may be corrected by surgery to restore the normal depth and function of the vagina. Symptoms such as back pain, pelvic pressure and painful sex may not be relieved by surgery to repair the prolapse. However, the chances of getting some degree of relief are quite good.

Prolapse can recur after surgery. The factors that caused a woman to have prolapse in the first place can cause it to occur again.

Source: American College of Obstetricians and Gynecologists.