Pelvic Prolapse Symptoms
Pelvic organ prolapse symptoms are mostly subtle, and the patient may not notice them. However, the most commonly reported symptom is abdominal or vaginal pressure. Other pelvic prolapse related symptoms may include
- Strain or discomfort of the lower back or groin
- Visible protrusion from the vaginal opening
- Pain during sexual intercourse
- Vaginal spotting or bleeding
- Loss of vaginal muscle tone
- Urinary incontinence (frequent urination)
- Bowel problems such as constipation
Some pelvic organ prolapse symptoms may worsen throughout the day and while lifting or stooping. The discomfort may lessen while lying down.
What is pelvic organ prolapse?
The pelvic floor is a hammock-like muscle that holds the female organs in place. The term prolapse describes a descending or sagging of organs. When the pelvic floor prolapses, the affected organs include the uterus, bladder, vagina, small bowel, and rectum.
Pelvic floor prolapse occurs when the pelvic floor muscles become weakened or damaged, allowing one or more of the female organs to slip through. In most cases, the organ falls through the pelvic floor and only reaches the outer opening of the vagina or anus. In advanced prolapse, one or more organs may fall through the pelvic floor and become visible from the external vaginal or anal opening. Pelvic floor disorders often follow childbirth, but can also be caused by other situations.
Understanding types of pelvic organ prolapse
There are other medical terms doctors may use to describe particular types of pelvic organ prolapse.
Urethrocele is a rounded protrusion of the urethra through the external opening of the vagina. Urethral prolapse is a rare condition that is most common in postmenopausal women of all ethnicities and pre-pubertal females of color.
Uterine prolapse occurs when pelvic floor lining weakens, providing insufficient support. The uterus slips through the weakened floor and into the vagina.
Enterocele is a small intestine (small bowel) prolapse that occurs when the small intestine pushes through the pelvic floor and creates a bulge the top or outer vaginal opening.
Rectocele is a rectal prolapse occurring when part or all the rectal wall descend through the rectal cavity.
Exploring causes of pelvic organ prolapse
Pelvic support comes from the pelvic floor, connective tissue, and ligaments. When the pelvic floor becomes weakened, it leaves the ligaments to bear the weight. Eventually, the organs will drop and press into the vaginal wall, causing prolapse.
Abdominal or vaginal stresses are the most common causes of pelvic organ prolapse disorders. Childbirth, sexual trauma, and age may also cause damage to the pelvic floor. Other stresses like constipation, chronic cough, or obesity can also strain or damage the pelvic muscles.
There are a few other circumstances that cause abdominal pressure and can result in pelvic organ prolapse. Abdominal bloating and cancer-related female disorders sometimes cause these problems. Sexual trauma, hysterectomies or other abdominal or vaginal procedures can also weaken the pelvic floor. Certain genetic connective tissue disorders may be a factor in pelvic organ prolapse.
Risk factors for pelvic organ prolapse
Some physicians believe that about 50 percent of all women experience some form of pelvic organ prolapse after childbirth. Most pelvic prolapse cases go undiagnosed and untreated. Less than 20 percent of women seek medical treatment for pelvic prolapse symptoms.
Certain factors increase the risk of pelvic organ prolapse, including
- Multiple pregnancies
- Vaginal birth and the size of the baby
- Pelvic or abdominal surgery
- Chronic bowel conditions
- Genetic connective tissue disorders
Diagnosing pelvic organ prolapse
A pelvic organ prolapse can be difficult to diagnose because most cases do not present clear symptoms. Many patients are aware something is wrong, but often do not realize a prolapse exists. Pelvic organ prolapse diagnosis generally occurs during a routine pelvic exam.
Most doctor appointments start with patients completing a medical history form, in which they will fill out a questionnaire section. Within the questionnaire section, the patient details any symptoms or signs of concern. Doctors use this information to help decide which diagnostic measures are needed.
If doctors suspect a pelvic prolapse, they may order a pelvic exam. During the pelvic exam, patients may be asked to perform an abdominal push, much like having a bowel movement or pushing to have a baby. The abdominal push allows doctors to assess prolapse occurrences and their degree of severity. Doctors also check the elasticity of the vaginal wall during the pelvic exam by asking patients to tighten the vaginal muscles.
Further testing may be ordered to diagnose different prolapse types. Pelvic prolapse testing may include
- Cystoscopy – a test using a small tube with a lighted camera attached to the end. The tube is inserted into the urethra and bladder so that doctors can access the place of the bladder.
- Intravenous pyelogram (IVP) – an internal x-ray of the pelvic organs. During an IVP exam, an iodine type liquid is injected into the veins; then doctors trace the liquid with a radiograph x-ray machine to determine the condition of the pelvic organs.
- Computed tomography scan (CT scan) – a scan that uses x-ray equipment to take detailed pictures of the pelvic area.
- Urodynamic testing – a procedure that focuses on the bladder's ability to retain and empty efficiently.
Pelvic organ prolapse treatment
Mild forms of pelvic organ prolapse may be reversible with pelvic exercise. Strengthening pelvic floor muscles may help pull minor prolapses back into place and restore elasticity to the pelvic lining.
Kegel exercises help tone the vaginal muscles and realign the pelvic organs. Follow these steps to perform a Kegel exercise.
- Insert one finger into the vagina.
- Tighten the vaginal muscles around the finger.
- Relax the muscles.
You should feel the pelvic wall tighten and retract as you perform the exercise. After the first session, you no longer need to insert a finger. The first step is only necessary to help you gauge vaginal muscle tension while you are learning to perform Kegels correctly.
For future sessions, repeat these steps 2 and 3 ten times for ten seconds each. Perform the exercise three times each day.
Knee to chest exercises
To perform these exercises, lay flat on your back on a firm surface. Bend both knees so that both feet are resting on the floor. Leave one foot on the floor and bring the other knee to your cheek for 30 seconds. Repeat this action with the other leg. Perform these steps three times daily.
The kangaroo walk strengthens the pelvic muscles and realigns the female organs by pulling the pelvic muscles forward with each step. First, get on your hands and knees. Arch your back and keep this position as you walk on all fours. Repeat this exercise a few minutes daily.
Medical and surgical treatments
Exercise and hormonal replacement often do not resolve severe forms of pelvic organ prolapse. In these cases, medicines or surgical measures may be needed.
- Hormone replacement therapy (HRT) helps restore pelvic floor tissues and vaginal moisture. However, HRT is not recommended at the beginning of treatment
- A pessary is a silicone mesh sling used to replace the damaged pelvic lining.
- Laparoscopic surgery is a procedure that uses small incisions and camera-guided tools to reposition pelvic organs.
- A hysterectomy Is used to remove the uterus or bladder surgically
- UPLIFT procedure is a recent procedure designed to reposition a tilted uterus
Preventing pelvic organ prolapse
The best prevention for pelvic organ prolapse is to reduce pelvic or abdominal stress. Avoid strain and heaving lifting, exercise and include pelvic exercises, and avoid rough sexual situations. Smoking can cause a chronic cough, so it may be wise to avoid smoking. Post-menopausal women should take estrogen supplements on a regular basis.
Pelvic prolapse is a common occurrence in aging woman and woman who have had multiple pregnancies. Other situations may also lead to pelvic organ prolapse. If you notice prolapse signs or symptoms, do not be embarrassed to tell a doctor. If caught in time, pelvic organ prolapse can be managed or even resolved with minimal effort.