Pelvic Floor Disorders
(Pelvic Organ Prolapse)
Pelvic floor disorders involve a dropping down (prolapse) of the bladder, rectum, or uterus caused by weakness of or injury to the ligaments, connective tissue, and muscles of the pelvis.
Pelvic floor disorders occur only in women and become more common with age. About 1 of 11 women needs surgery for a pelvic floor disorder during her lifetime.
The pelvic floor is a network of muscles, ligaments, and tissues that act like a hammock to support the organs of the pelvis: the uterus, bladder, and rectum. If the muscles become weak or the ligaments or tissues are stretched or damaged, the pelvic organs may drop down and protrude into the wall of the vagina. If the disorder is severe, tissues may protrude all the way through the vagina and outside the body.
Pelvic floor disorders usually result from a combination of factors. Being pregnant and having a vaginal delivery may weaken or stretch some of the supporting structures in the pelvis. Pelvic floor disorders are more common among women who have had several vaginal deliveries, and the risk may increase with each delivery. The delivery itself may damage nerves, leading to muscle weakness. Delivery by cesarean section may reduce the risk of developing a pelvic floor disorder.
Obesity, chronic coughing (for example, due to a lung disorder or smoking), frequent straining during bowel movements, and heavy lifting can also contribute to pelvic floor disorders. Other causes include a hysterectomy, nerve disorders, injuries, and tumors. Some women are born with weak pelvic tissues. As women age, the supporting structures in the pelvis may weaken, making pelvic floor disorders more likely to develop.
Types and Symptoms
All pelvic floor disorders are essentially hernias, in which tissue protrudes abnormally because another tissue is weakened. The different types of pelvic floor disorders are named according to the organ affected. Often, a woman has more than one type. In all types, the most common symptom is a feeling of heaviness or pressure in the area of the vagina-a feeling that the uterus, bladder, or rectum is dropping out.
Symptoms tend to occur when the woman is upright and to disappear when she is lying down. For some women, sexual intercourse is painful. Mild cases may not cause symptoms until a woman is older.
A rectocele develops when the rectum drops down and protrudes into the back wall of the vagina. It results from weakening of the muscular wall of the rectum and the connective tissue around the rectum. A rectocele can make having a bowel movement difficult and may cause a sensation of constipation. Some women need to place a finger in the vagina to have a bowel movement.
An enterocele develops when the small intestine and the lining of the abdominal cavity (peritoneum) bulge downward between the uterus and the rectum or, if the uterus has been removed, between the bladder and the rectum. It results from weakening of the connective tissue and ligaments supporting the uterus. An enterocele often causes no symptoms. But some women have a sense of fullness or feel pressure or pain in the pelvis. Pain may also be felt in the lower back.
A cystocele develops when the bladder drops down and protrudes into the front wall of the vagina. It results from weakening of the connective tissue and supporting structures around the bladder. A cystourethrocele is similar but develops when the upper part of the urethra (bladder neck) also drops down. Either of these disorders may cause stress incontinence (passage of urine during coughing, laughing, or any other maneuver that suddenly increases pressure within the abdomen) or overflow incontinence (passage of urine when the bladder becomes too full). After urination, the bladder may not feel completely empty. Sometimes a urinary tract infection develops. Because the nerves to the bladder or urethra can be damaged, women who have these disorders may develop urge incontinence (an intense, irrepressible urge to urinate, resulting in passage of urine).