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:
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).
Symptoms of pelvic support problems depend on the organ involved. Some symptoms include:
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.
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.
Treatment depends on what the specific problem is, how severe it is, and your general health and wellbeing.
A lot can be done to improve or prevent pelvic support problems:
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.