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Conditions We Treat / Women’s Health / Pelvic Floor Weakness

Pelvic Floor Weakness/Prolapse


JarReading

Pelvic floor prolapse occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or even outside of the vaginal opening.

Types of pelvic floor prolapse:

  • Bladder (cystocele): A hernia-like disorder that occurs when the wall between the bladder and the vagina weakens, causing the back wall of the bladder to bulge into the vagina.
  • Rectum (rectocele): A hernia-like disorder in which the wall between the rectum and the vagina weakens, causing the front wall of the rectum to push into the vagina.
  • Small bowel (enterocele): A hernia-like disorder, occurring in women who have had a hysterectomy, which occurs when the small bowel protrudes into the top of the vagina.
  • Uterus (uterine prolapse): A condition when the uterus droops into the vagina and starts to drop through the vaginal opening.

Cause:

A pelvic floor prolapse occurs when the weight-bearing or stabilizing structures that keep the vagina in place weaken or deteriorate. Common factors that may cause a pelvic floor prolapse include the following:

  • Childbirth (especially multiple births)
  • Menopause
  • Hysterectomy
  • Advanced age
  • Obesity

Symptoms:

The symptoms associated with a pelvic floor prolapse depend on the type. But the most common symptom of all prolapse conditions is the sensation that tissues or structures in the vagina are out of place. The following are general symptoms of all types of pelvic floor prolapse:

  • Pressure or fullness in the vagina or pelvis
  • Painful intercourse (dyspareunia)
  • Recurrent urinary tract infections
  • Difficulty emptying the bowel and/or bladder
  • Constipation
  • Urinary stress incontinence
  • Pain that increases during long periods of standing
  • A lump or protrusions of tissue at the opening of the vagina

Diagnosis:

A physical examination is the most reliable way to make a definite diagnosis.

Treatment:

Most worsening pelvic floor prolapses can only be fully corrected with surgery. The severity of the prolapse, whether the woman is sexually active, and her treatment preference all factor into this decision.

Nonsurgical treatments include:

  • Activity modification: The physician may recommend activity modification such as avoiding heavy lifting or straining.
  • Pessary: This is a small plastic or silicone medical device inserted into the vagina for support.
  • Kegel exercises: Simple strengthening exercises that can tighten the muscles of the pelvic floor.
  • Estrogen replacement therapy. Estrogen helps strengthen and maintain muscles in the vagina.

Surgical treatments include:

  • Vaginal surgery with mesh: The physician uses a mesh “kit” to pull the vagina up to the sacrospinous ligament (near the sacrum, the triangular bone just above the tailbone). The FDA recently warned that mesh could introduce risks that are not present in traditional non-mesh surgery, including: mesh erosion (exposure of the mesh in the vagina); mesh contracture (shrinkage); pelvic pain; pain with intercourse; bleeding; and infection.
  • Abdominal surgery using mesh: In this procedure, the mesh pulls the vagina up to the sacrum (called a sacrocolpopexy). This can only be done in women who have had a hysterectomy. While this has traditionally been considered the “gold standard” for prolapse surgery, it requires abdominal surgery with longer post-operative recovery. Abdominal surgery also raises risks of intra-abdominal injuries, or bowel injury, but these are uncommon. The FDA warning about mesh does not apply to this procedure.
  • Vaginal surgery without mesh: This treatment can involve repair with either a suture or with biological material, such as pigskin. These repairs don’t always hold up over time.

Additional Resources:

For more information on Pelvic Floor Weakness/Prolapse, visit WebMD's Pelvic Organ Prolapse page.


 

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