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The Methodist Center for Restorative Pelvic Medicine
6550 Fannin Street
Houston, TX 77030
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Pelvic floor prolapse is a condition that affects women. It is associated with weakness of the muscles and ligaments that hold the pelvic organs in their proper place. The pelvic floor is the group of muscles, ligaments and tissues that support the pelvic organs, which include the uterus, bladder and rectum. In some cases, these organs may protrude (drop) down low enough to hang outside of the body.
Pelvic floor prolapse is often referred to as hernia, and some women may even have more than one type. Each type of prolapse has a different name, depending on which organs are affected:
Bladder prolapse – Under normal conditions in women, the bladder is held in position by a "hammock" of supportive pelvic floor muscles and ligaments. When these muscles and tissues are stretched and/or weakened, the back of the bladder can sag through this layer of muscles and ligaments and into the vagina, resulting in bladder prolapse, also referred to as a cystocele. Some physicians consider this a type of hernia. In severe cases, the sagging bladder will appear at your vaginal opening and can even protrude (drop) through it.
Cystocele – The actual drop down of the bladder bulges into the anterior wall of the vagina.
Urethrocele – The prolapse of the female urethra into the vagina. A similar condition, called a cystourethrocele, occurs when the upper part of the urethra (bladder neck) also drops.
Uterine prolapse – The uterus can drop into the vagina if the connective tissues and ligaments that support the uterus are severely weakened. The uterus may fall and bulge into the upper part of the vagina, the middle of the vagina or all the way through the opening of the vagina (total uterine prolapse, or procidentia).
Vaginal prolapse – The upper part of the vagina begins to drop into the lower part, causing the vagina to turn inside out. The upper section may drop either part of the way or completely through the vagina causing the upper part to protrude outside the body. This condition is referred to as total vaginal prolapse.
Vaginal vault prolapse – The upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina. This condition is usually caused by weakness of the pelvic and vaginal tissues and muscles. It happens most in women who have had a hysterectomy.
Rectal prolapse - The rectum, the lower portion of the colon, turns itself inside out and protrudes through the anus. While this condition most often affects women, it can also occur in men.
Enterocele – The small intestine and the lining of the abdominal cavity (called the peritoneum) bulge downward between the uterus and the rectum. An enterocele results from the weakening of connective tissues and ligaments that support the uterus. This particular condition has no symptoms but some women may experience pressure or pain in the pelvis and in the lower back. This can also occur after a hysterectomy.
Rectocele – The rectum protrudes and breaks into the posterior wall of the vagina. This condition can make a bowel movement extremely difficult, and the woman may feel as though she is constipated.
The causes of pelvic-organ prolapse are similar to those that contribute to urinary incontinence. The primary cause is weakening of the pelvic-floor muscles and connective tissues that support the uterus and vagina. Vaginal childbirth may cause nerve injury to the pelvic-floor muscles that results in pelvic-floor weakening. Few women have symptoms of prolapse initially because other muscles around the pelvic floor can help to compensate. As women age, the muscles lose some of their strength and the prolapse becomes more noticeable. Other factors that have been linked to pelvic-organ prolapse include:
- Heavy lifting
- Chronic coughing
- Previous pelvic surgery
- Neurologic problems – such as injury to the spinal cord
Pelvic-organ prolapse has many symptoms but the most reliable is the presence of a bulge outside of the vagina. Other symptoms of prolapse include difficulty with urination or constipation and the sensation of something falling out of the vagina. Symptoms may include:
- Stress incontinence – urine passes when the patient coughs or laughs, causing pressure within the abdomen
- Frequent urinary tract infections (UTI)
- Development of urge incontinence – a sudden and immediate need to urinate, in which an accident can occur
- Pain in the lower back and/or near the tailbone
- Pain when sitting or walking
- Frequent need to urinate or difficultly urinating and/or having a bowel movement
- Discomfort or pain in the vagina, pelvis, lower abdomen, groin or lower back
- Heaviness or pressure in the vaginal area
- Tissue protruding from the vagina that may be tender and/or bleeding
- Painful intercourse
- In the case of a total uterine prolapse:
- Pain when walking
- Presence of sores on the cervix or vaginal mucosa, which can cause bleeding, discharge and infection
- Difficulty having a bowel movement
Symptoms of rectal prolapse depend on the amount of prolapse:
- Early in the course of rectal prolapse, the rectum does not protrude through the anus. The patient may have difficulty evacuating stool and may experience chronic pelvic pain.
- With progression of the condition, the rectum protrudes through the anus. The patient may experience anal pain, bleeding and a mass outside the anus. These symptoms are very similar to a prolapsing hemorrhoid.
- With time, the rectal prolapse will stretch the anal sphincter muscle. The patient may experience decreased control of gas and stool. This incontinence may be reversible with appropriate therapy.
Treatment for pelvic-organ prolapse usually depends on the severity of the symptoms and how much these symptoms interfere with daily activities and general quality of life. Treatments may include:
- Estrogen replacement therapy
- Electric stimulation
- Biofeedback techniques
- Kegel exercises
- Pessary (vaginal support devices)
Some types of prolapse, if left untreated, may get worse. In rare cases, severe prolapse can cause urinary retention, which may lead to kidney damage or infection.
Talk to our specialists
These issues can be embarrassing, but can be resolved. Your first step is to talk with one of our specialists. Call the Center for Restorative Pelvic Medicine at 713-441-9229 to find the right specialist and to schedule an appointment.
How to make an appointment
To schedule an appointment with a physician specializing in pelvic floor prolapse, please call the Center for Restorative Pelvic Medicine at 713-441-9229.