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, one or more of the organs in the pelvic area of your body may drop down into or out of the vagina. This is called prolapse. An organ may even drop so far that it is partially or totally exposed outside the body.

The main types of pelvic support problems include:

• Cystocele: When the bladder drops down into the vagina.
• Enterocele: When the small intestine drops into the vagina.
• Rectocele: When the rectum bulges into the vaginal wall.
• Uterine prolapse: When the uterus drops into the vagina.
• Vaginal prolapse: When the top part of the vagina begins to droop.

How do they occur?

Pelvic support problems can be caused by many conditions. The problem may start after you give birth, especially if you had a large baby. This can happen because the muscles and skin of the birth canal (vagina) are stretched and sometimes torn during childbirth. They heal over time but are never exactly the same. A long second stage of labor--that is the time from when you are fully dilated to when you push out the baby--may also weaken the tissues.

The hormone estrogen helps to keep the tissues toned. After menopause, your body has less estrogen. The decrease in hormone levels causes changes in the vaginal walls. The walls weaken and get thinner, 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.

An enterocele or vaginal prolapse may happen after removal of the uterus (hysterectomy).

What are the symptoms?

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

• leaking of urine when you cough, sneeze, laugh, or lift or during sex
• trouble with bowel movements (such as infrequent bowel movements or leaking of bowel movements)
• aching in the lower abdomen, groin, or lower back
• frequent and painful urination (symptoms of 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
• feeling tissue sticking out of the opening of the vagina
• painful sexual intercourse

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 then come back at an older age.

How are they diagnosed?

Your healthcare provider will ask about your symptoms and do a pelvic exam. Your provider may also do a rectal exam during the pelvic exam. Your provider may ask you to bear down and push as you would to have a bowel movement so he or she can see if your bladder or another part of your body bulges into the vagina. Your provider may also ask you to contract the muscles of your pelvis (as if you would to stop urinating) to check the strength of your pelvic muscles. You may be examined in different positions: lying down, standing up, and squatting. A complete exam will also include a rectal exam.

You may also have blood and urine tests and tests of the nerves and muscles of the pelvis and around the bladder to see what treatment is best for your.

How is it treated?

Treatment depends on what the specific problem is, how severe 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 they cough, strain, or exercise. 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, or the uterus may be removed.

How can I take care of myself or prevent pelvic support problems?

A lot can be done to improve or prevent pelvic support problems:

• If you are overweight, lose weight and try to keep a healthy weight.
• Eat high-fiber foods to help you move your bowels without straining.
• Strengthen your pelvic muscles by doing Kegel exercises. When you do Kegels, you alternately contract and relax your pelvic muscles as though you were trying to stop a flow of urine in midstream. It is especially helpful to do these exercises after you have delivered a baby.
• Avoid wearing tight girdles or other garments that put 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 are a smoker, quit.

If you have problems with leaking of urine, try to empty your bladder regularly before you have the urge to go. This will reduce the chance that urine will leak. You may also want to wear a pad to absorb wetness in the event of leakage.

If you are concerned about the effect of childbirth on your pelvic tissues, discuss this with your healthcare provider before delivery.