Pelvic Support Problems

What are pelvic support problems?

Ligaments, muscles, and connective tissue normally hold your bladder, rectum, uterus, and other organs in their proper places in your pelvis. When these tissues become weak, a problem with pelvic support may result. Weak support can cause one or more of the pelvic organs to drop down into or out of the vagina. The organ may even drop so far that is partially or totally exposed outside the body.

The main types of pelvic support problems include:

• Cystocele: When the bladder drops down into your vagina.
• Enterocele: When your small intestine drops into your vagina, usually after hysterectomy.
• Rectocele: When your rectum bulges into the vaginal wall.
• Uterine prolapse: When your uterus drops into your vagina.
• Vaginal prolapse: When the top part of the vagina begins to droop. This sometimes happens after a hysterectomy (removal of the uterus).

How do they occur?

Pelvic support problems can be caused by many conditions. Your problem may begin after you give birth, especially if you had a large baby. During childbirth, the muscles and skin of the birth canal (vagina) are stretched and sometimes torn. They heal over time but are never exactly the same. A long second stage of labor may also weaken these tissues.

Also, after menopause, there are changes in the vaginal walls resulting from a decrease in estrogen. Estrogen helps to keep the tissues toned. When there is less estrogen, the vaginal walls weaken and the bladder may shift from its normal position. As women get older, the loss of muscle tone and the relaxation of muscles may cause the uterus or other organs to drop.

Over time, certain conditions, like chronic coughing, chronic constipation, doing a lot of heavy lifting, straining to pass stool, and obesity, can also weaken the pelvic support muscles.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and do a pelvic examination. Your provider may also do a rectal exam during your pelvic exam. Your provider may ask you to bear down and push (like you are having a bowel movement) so he or she can see if your bladder or other part of your body protrudes into the vagina. Your provider may also ask you to contract the muscles of your pelvis (like you are stopping the stream in the middle of urinating) to check the strength of your pelvic muscles. You may be examined in different positions: lying down, standing up, and squatting.

Your provider may also do several types of urine tests and tests of the nerves and muscles of the pelvis and around the bladder to see what treatment is best for you.

What are the symptoms?

Symptoms of pelvic support problems depend on the organ involved. Some symptoms include:

• urine leakage
• trouble with bowel movements (infrequent bowel movements or leaking of bowel movements)
• ache in the lower abdomen, groin, or lower back
• bladder infection
• a feeling of heaviness, pulling, or fullness in the pelvis, or a feeling that something is falling out of the vagina, especially around the time of your menstrual period
• an organ protruding from your vaginal opening
• painful sexual intercourse

Many women have the feeling of pelvic pressure or trouble holding their urine immediately after childbirth. For some, these symptoms go away for a while but then return as they get older.

How is it treated?

A prolapsed organ cannot repair itself. Contact your healthcare provider as soon as you notice symptoms of a problem. Treatment depends on what the specific problem is, how advanced it is, and your general health and wellbeing.

• The symptoms caused by some pelvic support problems may simply be treated with changes in diet, medicine to soften the stool, weight loss, or avoiding strenuous activities. You may also need to do Kegel exercises to help strengthen your pelvic muscles.
• Advanced cases of prolapse may require a special plastic or rubber device called a pessary that fits into the vagina to support the uterus, vagina, or bladder. A pessary can help women who leak urine when coughing, straining, or exercising. In milder cases, a large tampon or vaginal diaphragm might be used instead of a pessary.
• In serious cases, surgery may be needed to put the organs back into their proper place. The uterus may be removed or suspended.

How can I prevent pelvic support problems?

You can help prevent pelvic support problems by:

• having a healthy lifestyle
• doing Kegel exercises, especially after having a baby
• keeping a healthy weight
• avoiding a lot of heavy lifting
• preventing constipation with a healthy, high-fiber diet, regular exercise, and plenty of fluids
• treating a chronic cough

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