The uterus isn’t the only pelvic organ that can prolapse

Yesterday I wrote about uterine prolapse. When the muscles of the pelvic floor are are stretched or torn by childbirth, the uterus can slip down into the vagina. This can distort the relationship between the sphincter that controls release of urine from the bladder into the urethra leading to stress urinary incontinence.

But the uterus isn’t the only organ that can fall through the pelvic floor. As the image above demonstrates, the bladder or the rectum can also fall through.

When the bladder falls through it is called a cystocele.

As the Urology Care Foundation explains:

Under normal conditions in women, the bladder is held in place by a “hammock” of supportive pelvic floor muscles and tissue. When these tissues are stretched and/or become weak, the bladder can drop and bulge through this layer and into the vagina. This results in bladder prolapse, also called cystocele. In severe cases, the prolapsed bladder can appear at the opening of the vagina. Sometimes it can even protrude (drop) through the vaginal opening…

A cystocele is often referred to as an anterior vaginal wall prolapse.

Symptoms include:

– a vaginal bulge…
– frequent voiding or the urge to pass urine
– urinary incontinence (unwanted loss of urine)
– not feeling relief right after voiding
– frequent urinary tract infections …
– sex that is painful …

Not surprisingly a cystocele can distort the relationship between the sphincter that controls release of urine from the bladder into the urethra. Although the sphincter itself has not been damaged, it nonetheless prevents the woman from “holding” urine. The sphincter works well enough that urine doesn’t constantly dribble out of the urethra, but when the intra-abdominal pressure is dramatically increased as occurs during coughing and sneezing, urine squirts out (stress urinary incontinence).

Although it is possible for the bladder alone to prolapse, it is more commonly accompanied by (or even caused by) uterine prolapse.

Just as the bladder can prolapse anteriorly, the rectum can prolapse posteriorly. This is known as a rectocele.

Symptoms include:

– A sensation of pressure or fullness in your rectum or vagina.
– A soft bulge of tissue …
– Feeling that your rectum hasn’t completely emptied after pooping.
– Having the urge to poop several times a day.
– Experiencing discomfort during intercourse …
– Having to press your fingers on the bulge in your vagina to push out a stool during a bowel movement …

Voices for Pelvic Floor Disorders publishes a fantastic fact sheet about prolapse.

What are the risk factors for pelvic organ prolapse?

-Pregnancy and childbirth: One in three women who gave birth has prolapse. Being pregnant and having a vaginal delivery can damage the pelvic muscles and nerves, allowing the organs to drop. This is particularly true of women who had a large baby, needed forceps to deliver, or had many babies.

– Aging and menopause: Loss of estrogen with menopause, along with other changes with aging, can weaken the pelvic floor. POP becomes more likely with age.

– Certain health conditions: Health problems that involve repeated straining, such as obesity, chronic cough, and constipation, can injure the pelvic floor over time.

– Heavy lifting: Extreme weight lifting or picking up heavy items on a repeated basis can increase POP risk. • Genetics: Genes help determine the strength of the connective tissue, so if your mother had POP, you are more likely to develop POP.

Very few of these are modifiable risk factors but:

You can try to prevent the prolapse worsening by making lifestyle and behavior changes. For example, to prevent the prolapse from worsening, eliminate constipation and do not strain with bowel movements. Plus, stop extreme weight lifting activities and avoid repeated heavy lifting. Keep your weight in a normal range and lose weight, if you are overweight. Lastly, quit smoking-tobacco use doubles your risk for pelvic floor disorders, such as POP.

In a future post we’ll review treatments for pelvic organ prolapse.