The Harvard Medical School Family Health Guide explains pelvic support comes from pelvic floor muscles, connecting tissue, and thickened pieces of fascia that serve as ligaments. When pelvic floor muscles weaken, the fascia and ligaments have to bear the brunt of the weight.
Eventually, they may stretch and fail, allowing pelvic organs (vagina, cervix, uterus, bladder, urethra, small intestines and rectum) to drop and press into the vaginal wall creating pelvic organ prolapse.
There are many types of pelvic organ prolapse. The University of Michigan Health System says the most common is a cystocele (the bladder is pushed downward below its normal position).
Other types are:
* uterine prolapse (the uterus descends into the vagina and possibly through the opening)
*enterocele (the small intestine pushes against the back wall of the vagina, creating a bulge)
*vaginal vault prolapse (the top of the vagina protrudes into the lower vagina)
*urethrocele (the urethra presses into the front vaginal wall)
*rectocele (part of the rectum bulges into the back wall of the vagina)
The American College of Obstetricians and Gynecologists (ACOG) list causes of pelvic support problems, including prior pelvic surgery, connective tissue disorders, menopause, aging, intense physical activity. Factors that increase pressure in the abdomen, such as being overweight, constipation, straining to have a bowel movement, and chronic coughing may contribute to pelvic support problems. Genetics may be a factor.
Many women have no symptoms. Others have mild to severe symptoms. Harvard writes the most common are pelvic pressure, heaviness or fullness, leg fatigue, and low back pain.
ACOG added that there may be a bulge in the vagina; organs bulging from the vagina; pulling, aching or a feeling of pressure in the lower abdomen; urinary incontinence; needing to push organs back into the vagina to empty the bladder or have a bowel movement; problems with inserting tampons or applicators; and pelvic pressure that worsens with standing, lifting, or coughing as the day progresses.
Harvard said a prolapse can cause irritated vaginal tissues or pain during intercourse, as well as psychological stress.
If symptoms are mild, ACOG says lifestyle changes such as bladder training and weight loss can help. Other options are Kegel exercises which work to strengthen the pelvic floor. Or use of a pessary which, when inserted in the vagina, helps support the pelvic area.
For more severe cases, Harvard says surgery relieves symptoms and improves quality of life. Different types of pelvic reconstruction surgery allow the prolapsed organ to be repositioned and secured with stitches to the surrounding tissues and ligaments. The vaginal defects are also repaired.
ACOG warns prolapse can recur after surgery. Harvard stresses the chance of recurrence may be reduced if women avoid stress, such as heavy lifting or straining, and perform Kegel exercises regularly before and after surgery.
Sources:
Pelvic Organ Prolapse. MayoClinic.com by the Mayo Foundation for Medical Education and Research. Web 27 Nov 2011
http://www.mayoclinic.org/pelvic-organ-prolapse
Pelvic Organ Prolapse – Topic Overview. WebMD.com by WebMD, LLC. Web 27 Nov 2011.
http://www.webmd.com/urinary-incontinence-oab/tc/pelvic-organ-prolapse-topic-overview
What to do about pelvic organ prolapse? Harvard.edu by President & Fellows of Harvard College. Web 27 Nov 2011.
http://www.health.harvard.edu/fhg/updates/update0805c.shtml
Pelvic Organ Prolapse. Umich.edu by the Regents of the University of Michigan. Web 27 Nov 2011.
http://www.med.umich.edu/1libr/aha/umpelvicpro.htm
Pelvic Support Problems. ACOG.org by the American College of Obstetricians and Gynecologists. Web 27 Nov 2011.
http://www.acog.org/~/media/For%20Patients/faq012.ashx
Pelvic Organ Prolapse. HealthyWomen.org by National Women's Health Resource Center, Inc. Web 27 Nov 2011.
http://www.healthywomen.org/condition/pelvic-organ-prolapse
Reviewed December 13, 2011
by Michele Blacksberg RN
Edited by Jody Smith