Ligaments, muscles, and connective tissue normally hold your bladder, bowel, uterus, and other organs in their proper places in your lower belly (pelvis). If these tissues get weak, the bladder, bowel, or uterus may press into or drop down into the vagina. This is called prolapse.
The main types of pelvic support problems include:
Cystocele: the bladder drops down into the vagina.
Urethrocele: tissues around the urethra sag into the vagina
Enterocele: the small intestine drops into the vagina.
Rectocele: the rectum bulges into the vagina.
Uterine prolapse: the uterus drops into the vagina.
Vaginal prolapse: the top part of the vagina begins to droop.
What is the cause?
Pelvic support problems can be caused by many conditions.
The problem may start after you give birth, especially if you had a large baby or a long or difficult labor. The muscles and skin of the birth canal vagina are stretched and sometimes torn during childbirth. The tissues heal over time but may not be as strong as they were before.
As you get older a drop in hormones can cause a weakening of tissues. The hormone estrogen helps to keep the tissues strong and toned. After menopause, your body has less estrogen. The walls of the vagina get thinner and weaker.
Sometimes pelvic surgery, such as removal of the uterus, can cause prolapse of the vagina or small intestine.
Over time, the following may increase your risk of pelvic support problems:
Inherited weak ligaments and muscles
Frequent heavy lifting
Frequent straining to pass bowel movements
Injury to the vagina or pelvic muscles
What are the symptoms?
Symptoms of pelvic support problems depend on what part of the body has dropped into the vagina. You may not have any symptoms. If you do have symptoms, they may include:
Leaking of urine when you cough, sneeze, laugh, lift heavy objects, or have sex
Trouble with bowel movements (such as infrequent bowel movements or leaking of bowel movements)
Aching in the lower belly, groin, or lower back
Frequent and painful urination (symptoms of bladder infection)
A feeling of heaviness, pulling, or fullness in your lower belly, or a feeling that something is falling out of the vagina, especially around the time of your menstrual period
Feeling tissue sticking out of the opening of the vagina
Pain during sex
Many women have the feeling of pelvic pressure or trouble holding their urine right after childbirth. These symptoms may go away for a while but they may come back when you are older.
How are they diagnosed?
Your healthcare provider will ask about your symptoms and do a pelvic exam. You may also have a rectal exam. Your provider may ask you to bear down and push as you would to have a bowel movement to see if your bladder or another part of your body bulges into the vagina. Your provider may also ask you to squeeze the muscles of your pelvis (as you would to stop urinating) to see how strong they are. You may be examined in different positions: lying down, standing up, and squatting.
Tests may include:
Tests of the nerves and muscles of the pelvis and around the bladder
These tests can help your provider know what treatment might be best for you.
How are they treated?
Treatment depends on what the specific problem is, how severe it is, and your general health and wellbeing.
Lifestyle changes: Sometimes the symptoms can be treated with changes in diet, medicine to soften the stool, weight loss, or avoiding strenuous activities.
Kegel exercises: You may need to do Kegel exercises to help strengthen your pelvic floor muscles. When you do Kegels, you squeeze and relax your pelvic muscles as though you were trying to stop a flow of urine.
Pessary: A pessary is a silicone or plastic device prescribed by your healthcare provider. Itâ€™s inserted into the vagina to help support the uterus, bladder, and rectum. In some cases, you might use a large tampon or vaginal diaphragm instead of a pessary.
Surgery: In serious cases, you may need surgery to remove or repair weakened tissue and put the organs back into their proper place. In some cases, removal of the uterus (hysterectomy) may be recommended.
How can I take care of myself?
To improve or prevent pelvic support problems:
Follow your providerâ€™s advice for treatment.
Try to keep a healthy weight. If you are overweight, lose weight.
Eat high-fiber foods to help you move your bowels without straining.
Drink plenty of fluids.
Strengthen your pelvic muscles by doing Kegel exercises every day. It is especially helpful to do these exercises before and after childbirth.
Donâ€™t wear tight underwear or clothing that puts pressure on your belly.
Avoid frequent heavy lifting. When you do lift, bend your knees and hips and keep your back straight.
Treat a chronic cough. Treat and control asthma or chronic bronchitis.
If you smoke, try to quit.
If you have problems with leaking of urine, try to empty your bladder regularly before you have the urge to go. This will lessen the chance that urine will leak. You may also want to wear a pad to absorb wetness when you are doing something that may cause leaking (like running).
If you are concerned about the effect of childbirth on your pelvic tissues, discuss this with your healthcare provider before your baby is born.
Developed by RelayHealth.
Adult Advisor 2015.1 published by RelayHealth. Last modified: 2014-06-20 Last reviewed: 2014-06-20
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Pelvic Support Problems: References
ACOG Practice Bulletin: Pelvic Organ Prolapse, Number 85, September 2007. Reaffirmed 2011.
ACOG Practice Bulletin: Urinary Incontinence in Women, Number 63, June 2005. Reaffirmed 2013.
Lentz,G., R. Lobo, D. Gershenson, V. Katz. Comprehensive Gynecology. 6th ed. Mosby Elsevier, 2012.
Schorge, J., J. Schaeffer, L. Hoalvorson, B. Hoffmen, K. Bradshaw, F. Cunningham. Williams Gynecology. 1st ed. The Mcgraw Hill Companies, Inc. 2008.