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Straight Talk About Pelvic Prolapse

Call it a bad rap. Women tend to think the worst about pelvic prolapse. They imagine their uterus will fall out or worry that it’s a sign of cancer. Not only is pelvic prolapse more common than you might think – it’s also not as scary as you might imagine. 

Too often, women don’t speak up or suffer in silence. The good news is this condition can often be managed conservatively for years, but surgery is also an option if needed or desired.

Pelvic prolapse 

What exactly is pelvic prolapse? It occurs when muscles and tissue in your pelvic floor weaken and can no longer support pelvic organs, allowing them to drop down. It can occur with your bladder, rectum, uterus or top of the vagina. 

Picture being on one side of a curtain, and someone on the other side pushes a sofa up against the curtain and intrudes on your space. Now think of your vaginal wall as a curtain, and picture your bladder or rectum pushing up against that layer of separation. 

Things that make that “curtain” not as strong include pregnancy and vaginal childbirth, which weakens pelvic floor muscles, menopause, aging and repeated heavy lifting/chronic straining. Contributing factors include being overweight/obese, frequent constipation/straining during bowel movements and chronic coughing from smoking, asthma or other conditions. 

Symptoms and Signs of Pelvic Prolapse

Symptoms of pelvic prolapse can vary greatly. For some women, it might feel like the pressure of a misplaced tampon or like you’re sitting on a ball. These symptoms can change, for example  be worse some days or better in the morning and worse in the afternoon. Things to watch for include: 

  • Leakage of urine
  • Difficulty completely emptying bladder
  • Fullness or pressure in your pelvis or vagina
  • Lower back pain
  • Constipation or difficulty with bowel movements
  • Difficulty inserting tampons or applicators

Diagnosis and Treatment 

When should you talk to your doctor about pelvic prolapse? If you have troubling symptoms or if you’re just plain worried. 

To diagnose prolapse, a provider will take your history and perform vaginal and rectal exams, which may be while lying, standing, straining and coughing. Your bladder may be checked for complete emptying. 

If you can’t fully empty your bladder, or you have bleeding, my advice for treatment will likely be stronger. But I see lots of women who live with prolapses for years. What’s important is your quality of life and how much the prolapse bothers you. Treatment options include:

  • Watchful waiting. A prolapse can be stable for years without treatment. 
  • Pelvic floor exercises. This can strengthen those muscles and help with many of the symptoms related to prolapse. It can also be used in a preventive manner – before you have a prolapse. Seeing a physical therapist at least once to make sure you’re targeting the right muscles is a good idea. You can do pelvic floor strengthening exercises on your own or using an app or instructional material.
  • For rectum into vagina prolapse (rectocele), use good stooling techniques to limit bearing down and adjust your diet to avoid being constipated. 
  • Use a pessary. This device sits in the vagina and helps support the walls. Some women use it only for certain activities. Others may keep it in place for as long as six months at a time. This is something women can self-manage at home or a provider can help with maintenance. If you are self-managing, be sure to see a provider at least once a year, or earlier if you have discomfort, vaginal bleeding or excess discharge.
  • Surgery is an option and depends on the type of prolapse. Because a prolapse is similar to a hernia, a surgeon may use mesh or your own vaginal tissue to strengthen your  pelvic floor supports. For women who no longer desire sexual intercourse, surgically narrowing or closing vagina is a good option for a pelvic floor prolapse. Some women may need to consult a gastrointestinal or colorectal surgery specialist.

Pelvic prolapse can happen at any age, but most often occurs after menopause. The most important thing you can do is speak up when it bothers you. Let’s start by talking about your symptoms and ways to manage this condition. Something as simple as using proper lifting techniques or practicing pelvic floor exercises can help prevent prolapse or decrease its severity. If you have questions, reach out to your provider.

Kristen Gerjevic, MD
Kristen Gerjevic, MD

Kristen Gerjevic, MD is a Urogynecologist with CHI Health.

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