Patient Education

Pelvic Support Problems

As women age their bodies and reproductive organs change. During pregnancy these organs stretch and grow, and then must return back to a new "normal" after childbirth. Sometimes women may feel that their pelvic organs are "sagging" or "falling out". These symptoms may be caused by pelvic support problems. This page goes over basic information about pelvic support problems, their causes, and how they can be treated.

WHAT ARE THE PELVIC ORGANS?

The organs that are affected by pelvic support problems include the uterus, vagina, bladder, rectum, and small intestine. The bladder is located in front of the vagina. The bladder receives and stores urine that is produced and released by the kidneys. When the bladder is full, it then releases the urine out of the body through the urethra. The vagina extends from its opening to the cervix which is the base of the uterus. Behind the uterus lies the small intestine with the rectum ending at the anus. These pelvic organs are all held in place by three different types of support:    

  • Connective tissue 
  • Ligaments
  • Muscles

When one or more of these supports are damaged, the organs may droop or press against other organs, creating a bulge. Sometimes an organ will drop far enough to push through the vaginal opening.

WHAT CAUSES PELVIC SUPPORT PROBLEMS?

The two most common causes of pelvic support problems are pregnancy and childbirth. During pregnancy, many muscles and ligaments are stretched in order to make room for the baby to grow comfortably, which can cause permanent changes. During childbirth, the ligaments and fascia may be damaged when the baby passes through the birth canal. Both these situations can cause weakening of the support systems that can cause problems later on in life. However, women who have never been pregnant can still suffer from poor pelvic support.

WHAT ARE THE SYMPTOMS OF PELVIC SUPPORT PROBLEMS?

Because several organs can be involved in pelvic support problems, the symptoms you experience will vary depending on your specific situation. Some common symptoms include:    

  • Pulling or aching feeling in the pelvis
  • Feeling of pelvic heaviness or fullness
  • Feeling like something is bulging or falling out of the vagina
  • Leaking of urine or difficulty passing a bowel movement

Often, symptoms will be worse at the end of the day, or with activities such as coughing, sneezing, lifting, or straining. In more severe cases when pelvic organs are bulging from the vagina, they may be seen with a mirror or felt with fingers, and may need to be repeatedly pushed back into place. If this is the case, see your provider to discuss treatment options.

WHAT ARE THE DIFFERENT TYPES OF PELVIC SUPPORT PROBLEMS?

There are several different types of pelvic support problems:

  • Cystocele: A cystocele occurs when the bladder falls into the vagina. Cystoceles can cause many different urinary problems such as leaking urine or the inability to empty completely or at all. In some cases women may need push the bladder back into place nside the vagina in order to properly urinate. Urine leakage from a cystocele can be caused by sneezing, laughing, walking, jumping, or lifting objects. Although small cystoceles are common and may not need treatment, those that cause symptoms often do.
  • Vaginal Vault Prolapse: If a woman has had a hysterectomy, the support system of the vagina can be weakened significantly, causing varying degrees of dropping. This is called a vaginal vault prolapse. The vagina may stay within the canal, or it may droop out of the vaginal opening. This can cause other problems with bladder and bowel function as well.
  • Enterocele: Vaginal vault prolapse can be accompanied by an enterocele. An enterocele is a problem that occurs when part of the small intestine drops and bulges into the vagina.
  • Rectocele: A rectocele is a support problem that occurs when the rectum bulges into or out through the vagina. This occurs when the back wall of the vagina becomes weakened. Rectocele problems may make it difficult to pass a bowel movement, and sometimes women must push the bulge back into the vagina in order to pass stool.
  • Uterine Prolapse: This occurs when the uterus drops down into the vagina. Sometimes this causes pain, feelings of heaviness, or pain during sex. If severe, the uterus may bulge out of the vaginal opening.

HOW ARE PELVIC SUPPORT PROBLEMS DIAGNOSED?

Pelvic support problems can be difficult to identify because the symptoms can have many different causes. Most women will know that they have a problem, but the symptoms can be hard to describe. If you suspect you have pelvic support problems, see your provider for a thorough exam including the pelvic and rectal area.

HOW ARE PELVIC SUPPORT PROBLEMS TREATED?

Many women do not need treatment for their pelvic support problems if they are mild. Some women find that eating a healthy diet, exercising regularly, avoiding lifting or straining, losing weight and avoiding smoking all help improve symptoms. Further treatment may also be necessary for some.

  • Special Exercises: Exercises that work the pelvic floor muscles are often used to help minimize or reduce problems with support. These exercises, called Kegel exercises, are used to strengthen the muscles surrounding the pelvic organs.
  • Diet Changes: Cutting down on caffeine can be helpful, because caffeine irritates the bladder and makes women need to urinate more often. Also, eating foods high in fiber can help by making bowel movements pass more easily.
  • Medicines: Medications that can soften stools, bulk up stools, or help with bladder control. May help with symptoms of pelvic support problems.
  • Vaginal Pessaries: A pessary is a device that is placed into the vagina to help support the surrounding organs and to keep them from bulging. If a pessary is used, it must be cleaned regularly, or ulcers and infection can occur. When used correctly, pessaries can be effective for years. There are many different types of pessaries. Your provider will work with you to choose the fit that is right for you.
  • Surgical Repair: Surgery may be necessary for more serious forms of pelvic support problems. Often surgery is delayed until after a woman is finished with childbearing. Surgical options can involve removing their uterus and/or supporting the affected organs with synthetic or natural materials.

IN CONCLUSION…

Pelvic support problems are common among women. If you believe you are experiencing some of the symptoms, talk to your provider so you can find the treatment you need.