Many women suffer from pelvic organ prolapse, with as many as one-third of all US women being treated by the age of 60. By age 80, at least 1 out of 10 women will have undergone surgery for prolapse. Pelvic organ prolapse can affect a woman's daily life, limiting physical and sexual functioning. Women can be reluctant, and even embarrassed, to discuss it with their doctors or even each other.
Many women suffer unnecessarily from conditions involving pelvic relaxation. If you have any of these symptoms described in this section, contact us at (207) 907-7002 or use the Quick Contact form on the right. Appropriate diagnosis and treatment will often restore patients to a life free of the aggravations and discomforts associated with pelvic relaxation.
What is pelvic organ prolapse?
The vagina and uterus are secured by ligament-like structures in the pelvis. As the pelvic floor muscles weaken, these connective structures relax, causing the vagina to be displaced toward, and sometimes beyond, the vaginal opening. Because of the close proximities of the bladder, which is above the vagina, and the rectum, which is below, this relaxation can cause many symptoms including:
- loss of bladder and sometimes bowel control,
- difficulty urinating,
- frequent urination,
- problems with moving the bowels, such as constipation and incomplete emptying,
- feeling of pelvic or vaginal heaviness, bulging, fullness and/or pain, or a feeling that something has 'dropped',
- recurrant bladder infections,
- discomfort or lack of sensation during intercourse, and
- back pain.
What causes pelvic organ prolapse?
Age is a major factor in the cause of pelvic organ prolapse due to estrogen loss associated with menopause and loss of muscle tone. Multiple vaginal deliveries, obesity, family history, pelvic trauma or previous surgery, repeated heavy lifting, recurrent constipation, chronic coughing, and other medical conditions such as diabetes or connective tissue disorders can also contribute to pelvic organ prolapse.
Functional Gynecological Problems
The goal is to acquaint you with the various forms of pelvic relaxation as well as their causes, symptoms, and treatment. The pelvic organs include the vagina, uterus, bladder, and rectum. These organs are held in position by three types of supports: 1) muscles, 2) sheets of tissue called fascia and 3) ligaments. When these supports become damaged for various reasons, one or more of the pelvic organs may sag and, occasionally, even protrude outside the vagina. These are called pelvic support defects.
During childbirth, as the baby passes through the birth canal, the muscles, fascia, and ligaments separate and may be weakened. This weakening gradually worsens and, in later years, may cause the pelvic organs to drop from their normal positions.
Occasionally, this weakening of the muscles and tissue may occur in women who have never had children. In these women, the cause may be:
- Inherited weakness of the supporting tissues
- Unusual strain placed on the supporting tissues by a chronic cough
- Unusual increases in abdominal pressure
- Obesity
The general symptoms associated with pelvic relaxation depend on which organs are affected. Often there is a feeling of heaviness or fullness. Small or moderate amounts of urine may be lost with normal physical activities such as laughing, coughing, walking, or running. In more advanced and rare cases a mass may actually protrude from the vaginal opening. Based on the organ or organs involved, pelvic support defects can be defined more specifically as:
- Cystocele
- Rectocele
- Enterocele
- Urethrocele (most of the time the cystocele and urethrocele occur in combination - cystourethrocele)
- Uterine prolapse
A cystocele occurs when the bladder falls or descends from its normal position. The most common symptom associated with cystocele is difficulty in completely emptying the bladder. This can be associated with bladder infections. Large cystoceles can cause the bladder to overfill and allow small amounts of urine to leak. Leakage is most common during activity such as walking or bouts of coughing.
Rectoceles usually occur as a result of injuries sustained during childbirth. With a weakened or bulging rectum, bowel movements become more difficult.
An enterocele is the bulging of small intestines into the back wall of the vagina.
A urethrocele usually occurs in conjunction with a cystocele. Both of these conditions result in, among other things, involuntary loss of urine, particularly when there is increased pressure in the abdomen, caused by walking, jumping, coughing, sneezing, laughing, or sudden movements. Rectoceles happen when the rectum bulges into or out of the vagina.
Uterine prolapse occurs when the uterus falls or is displaced from its normal position. There are varying degrees of severity depending on the descent. This produces a general felling of heaviness and fullness, or a sense that the uterus is falling out.
Vaginal vault prolapse happens when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina. It happens most in women who have had their uterus removed.
The diagnosis of these problems includes a through history and physical examination. Other test depending on the circumstances include a "Q-tip" test, urodynamic studies (a painless fifteen to twenty minute computerized bladder and urethra functional studies), urethrocystoscopy (instrument used to evaluate the inside of the bladder and urethra), X-rays of the urinary system.
For all practical purposes, definitive treatment is surgical correction of the specific defects.
