The “pelvic floor” is a group of muscles that form a kind of hammock across your pelvic opening. Normally, these muscles and the connective tissues surrounding them keep the pelvic organs in place. These organs include your bladder, uterus, vagina, small bowel, and rectum.
Sometimes, these muscles and tissue develop problems. Some women develop pelvic floor disorders following childbirth. And as women age, pelvic organ prolapse (POP) and other pelvic floor disorders become more common. When pelvic floor disorders develop, one or more of the pelvic organs may stop working properly.
Pelvic organ prolapse occurs when one or more pelvic organs fall from their normal positions. In mild cases, a slight bulge can be detected inside the vaginal canal. In severe cases, the affected organ may push a lump of tissue past the vaginal opening.
Conditions associated with pelvic floor disorders include:
- Uterine prolapse
- Vaginal prolapse, following a hysterectomy
- Bladder prolapse – affects the front (anterior) wall of the vagina, also known as a cystocele and may cause urinary incontinence
- Rectum – affects the back (posterior) wall of the vagina, also known as a rectocele
- The pouch of tissue between the uterus and rectum, sometimes including the small intestine, also known as an enterocele
Although not life-threatening, POP can be life-altering and may result in significant quality of life changes in women suffering from POP.
Symptoms of Pelvic Organ Prolapse
Pelvic organ prolapse can range from mild to severe.
While some patients with prolapse may not appear to have any symptoms, other common symptoms of pelvic organ prolapse include:
- Seeing or feeling a bulge or “something coming out” of the vagina
- A feeling of pressure, discomfort, aching, or fullness in the pelvis
- Pelvic pressure that gets worse with standing or coughing or as the day goes on
- Leaking urine (incontinence) causing urinary tract infections
- Problems having a bowel movement
- Problems inserting tampons
The pressure from prolapse can cause a bulge in the vagina that can sometimes be felt or seen. Women with pelvic organ prolapse may feel uncomfortable pressure during physical activity or sex.
Cause of Pelvic Organ Prolapse
Pelvic organ prolapse happens when the muscles or connective tissues of the pelvis do not work as they should. The most common risk factors are:
- Vaginal childbirth, which can stretch and strain the pelvic floor. Multiple vaginal childbirths raise your risk for pelvic organ prolapse later in life. But you can get prolapse even if you have never had children or if you had a cesarean, or C-section, delivery.
- Long-term pressure on your abdomen, including pressure from obesity, chronic coughing, or straining often during bowel movements
- Giving birth to a baby weighing more than 8½ pounds
- Aging. Pelvic floor disorders are more common in older women. About 37% of women with pelvic floor disorders are 60 to 79 years of age, and about half are 80 or older.
- Hormonal changes during menopause. Loss of the female hormone estrogen during and after menopause can raise your risk for pelvic organ prolapse.
- Researchers are not sure exactly why this happens.
- Family history. Researchers are studying how genetics can play a role in pelvic organ prolapse.
Some women indicated that their symptoms are worse at certain times of the day, during physical activity, or after standing for a long time. Talk to your health care doctor or nurse about your symptoms to confirm your medical condition.
Organ Prolapse Treatment
If your condition is mild and isn’t causing any symptoms, then your condition may not require any treatment. If you’re experiencing only slight discomfort, then your doctor may recommend a conservative, non-surgical treatment plan.
A vaginal pessary is a small, doughnut-shaped device made out of plastic or rubber that can be inserted into the vagina to lend extra support to the pelvic organs. Your gynecologist can insert the pessary for you the first time, and show you how to remove, clean, and re-insert the device on your own.
These are exercises designed to strengthen the pelvic floor muscles. They are easy to do and can be done anywhere, on your own time. Simply squeeze the muscles you would use to stop the flow of urine, hold for 3 seconds, then release. Perform 20 repetitions of this exercise 3-5 times per day.
Overweight or obese women can relieve some of the pressure on their pelvic organs by losing some weight. Your doctor can talk to you about some healthy ways to lose weight with diet and exercise.
Do not smoke
Smoking can lead to chronic coughing, which puts stress on the pelvic floor muscles.
If your prolapse is more severe, you may want to discuss surgical treatment options with your doctor. Your age, medical history, and particular risk factors will influence the type and timing of your surgery. For example, if you plan on becoming pregnant in the future, you may wish to postpone surgery until after the pregnancy.
Surgery for Pelvic Organ Prolapse
This procedure involves supporting the pelvic tissue by surgically closing off the vagina. After this procedure, you are no longer able to have penetrative vaginal sex.
In this approach, the goal is to place the pelvic organs to their original position and reconstruct the pelvic floor to provide more support to the organs. In most cases, sexual intercourse is still possible after you’ve made a full recovery.
Types of Reconstructive Surgery for Pelvic Organ Prolapse
There are several types of reconstructive surgery, which can be performed through an incision in the vagina, in the abdomen, or through laparoscopy.
Uterosacral ligament suspension and sacrospinous fixation
In this procedure, your pelvic organ(s) will be fixated or suspended using the surrounding tissues. It’s typically performed through the vagina, which can cut down on recovery time.
Colporrhaphy, anterior or posterior
This surgery involves strengthening either the front or back walls of the vagina with stitches, restoring support to the bladder or rectum. It is also commonly performed vaginally.
Sacrocolpopexy and sacrohysteropexy
Performed through incisions in the abdomen, these procedures involve suspending the prolapsed cervix or vaginal vault (in the case of hysterectomy) to a bone at the base of the spine. Although recovery time may be longer, there is less risk for lingering pain during vaginal intercourse.
In this procedure, the vaginal walls are supported by the placement of surgical mesh. This type of treatment carries risk of pain, infection, and erosion of the mesh over time. It’s generally only used when other procedures have failed to fix the problem, when abdominal surgery is too risky, or when the woman’s tissues have sustained significant damage.
Recovery from Reconstructive Surgery
Because the different surgical interventions are individualized to your case, full recovery times will vary. Generally speaking, you may need to take 3-5 weeks off work to rest and recover. During this time, you should avoid heavy lifting, strenuous exercise, and vaginal intercourse.