If you experience problems with pelvic organ support, you are not alone. This can be described as a sensation of bulging or pressure in the vagina, or the feeling of "falling down" in the vagina. The problem often begins after childbirth and may get progressively worse during the aging process. You may hear health care professionals refer to pelvic support problems as prolapse or herniation. Symptoms of pelvic support problems depend on the organ involved. Symptoms can range from mild to severe. They can include:
- Feeling of pressure, pelvic heaviness, bulging sensation or something falling out of your vagina
- Achy low back pain
- Bulge of the pelvic organs outside of your vagina
- Difficulty with bowel movements
- Difficulty emptying your bladder
- Urinary incontinence
Your symptoms of pelvic support problems may be worse at certain times, For example, at the end of a long day, especially after standing for long periods, or just prior to menstruation. Depending on where the prolapse is, it will affect the type of symptoms that you experience.
Types of Pelvic Support Problems
Specific pelvic support problems are designated by the organ bulging into the vagina. Often prolapse in more than one part of the vaginal wall occurs at the same time.
- Cystocele (bladder) - A cystocele is a weakness in the top wall of the vagina that results in the bladder bulging into the vaginal space. Some problems associated with a cystocele may include: A bulge from your vagina; incomplete emptying of your bladder.
- Rectocele (rectum) - A rectocele is weakness in the bottom wall of the vagina that allows the rectum to bulge into the vaginal space. You may have difficulty with complete evacuation during bowel movements, and therefore may have small, frequent bowel movements. Your doctor may do a rectal exam to help accurately diagnose a rectocele.
- Urethrocele (urethra) - An urethrocele is a protrusion of your urethra into your vagina. It may or may not be combined with a cystocele or symptoms of stress urinary incontinence (see above).
- Uterine prolapse (uterus) - Uterine prolapse occurs when there is a weakness in the supports of the uterus which results in a bulging or drooping low into the vagina.
- Vault prolapse (top of the vagina) - If you have had a hysterectomy, the top of your vagina can prolapse or fall into your vagina. This most often occurs in conjunction with an enterocele (a bulge of the small intestines into the top of the vagina).
Treating Pelvic Support Problems
We will do a complete history and physical exam. A pelvic exam will be performed while you are lying down and again while standing, if necessary. If you have problems with leaking urine or voiding completely, bladder function tests may be necessary. Treatment of pelvic support problems may include:
- Exercises - Kegel exercises, also called pelvic floor exercises, can help with pelvic support problems. The pelvic floor muscles are like a hammock, stretching from your pubic bone to your tailbone. These muscles support your internal organs including the bladder, intestines and uterus. Childbirth, repetitive lifting and chronic coughing can weaken these muscles.
- Pessary - A pessary is soft plastic device shaped like a ring and looks similar to a diaphragm. It is placed in your vagina to help support your bladder, rectum and uterus. The pessary can be used as a temporary measure to provide comfort until surgery takes place. You may elect to use a pessary long term to avoid surgery. It also is an alternative if you are not able to have surgery to correct your prolapse. Pessaries come in several sizes. Being fitted for a pessary takes less than 10 minutes and occurs during an office visit.
- Medications - Your doctor may suggest vaginal estrogen cream. After menopause, the support to your pelvic floor may weaken due to lack of estrogen. Estrogen cream may lessen symptoms of pressure in your vagina and improve the overall health of the tissue.
- Surgery - Surgery may be an option to correct pelvic support problems. It can be done through your vagina, abdomen or laparoscopically/robotically.