Pelvic Support Problems

Pelvic support problems can be caused by many conditions. Sometimes the problem begins after childbirth.  During childbirth, the muscles and skin of the birth canal (vagina) are stretched and sometimes torn. They heal over time but are never exactly the same.  A long second stage of labor (time spent pushing) may also weaken these tissues.

Also, after menopause, there are changes in the vaginal walls resulting from a decrease in estrogen.  Estrogen is a hormone that assists in keeping the tissues toned and healthy.  Low levels of estrogen weaken the vaginal walls and may cause the bladder to shift from its normal position. As women get older, the loss of muscle tone and the relaxation of muscles may cause the uterus or other organs to drop.

Other things such as chronic coughing, chronic constipation, being overweight, and even doing a lot of heavy lifting, can also weaken the pelvic support muscles over time.

Pelvic Organs

The parts of the body that can be affected by pelvic support problems include:

• the uterus
• the vagina
• the intestines
• the rectum
• the urethra and bladder

These organs are supported by three things:

1. Endopelvic fascia.  Fascia is a part of the connective tissue system found throughout the body.  It surrounds muscles, bones, organs, blood vessels, nerves and other structures and provides support and protection throughout the body.
2. Ligaments, which are thickened portions of the fascia.
3. Muscles around the openings of the urethra, vagina and rectum.

When these three things are damaged or stretched, it may allow the organ that they support to move and press against the vagina, causing a bulge.

Diagnosis

If a healthcare provider suspects pelvic support problems exist, she or he will probably do a pelvic and rectal exam.  During the exam, the woman is asked to bear down and push, and to contract the pelvic muscles.  There are several other types of tests, such as urine tests and tests of the muscles and nerves in the pelvic area that can be performed, depending on the symptoms.
 

Symptoms

Since several different organs can be affected, there are a wide variety of symptoms to watch for.  The most common include:

• Aches in the lower abdomen, groin or lower back
• Urine leakage
• Problems with bowel movements
• Frequent bladder infections
• A general feeling of heaviness, pulling, or fullness in the pelvis or vagina
• Pain during sexual intercourse

Some women have this feeling of heaviness or fullness in the pelvis after childbirth.  The symptoms usually go away on their own, but for some they return as the woman ages. 

Pelvic Support Problems

The main types of pelvic support problems include:

• Cystocele -When the bladder drops down into the vagina.  A cystocele can cause urine to leak or it may make it difficult to pass urine.  The bladder may not ever completely empty if a large cystocele is present.  
• Enterocele - When the small intestine drops into the vagina. It often occurs with a vaginal prolapse after a hysterectomy is performed.
• Rectocele – When the rectum bulges into the vaginal wall.  It is caused by weakness in the back wall of the vagina, and may make having bowel movements difficult.
• Uterine prolapse – Often occurs when other pelvic organs have dropped.  The uterus drops down into the vagina, causing a feeling of pulling or heaviness. 
• Vaginal prolapse – Sometimes when a hysterectomy is performed and the uterus is removed, the top part of the vagina begins to droop.  It can interfere with both bladder and bowel functions.

Treatment

A physician should be consulted both to diagnose and the recommend the best course of treatment for each case.  Treatments vary widely, depending on the specific diagnosis.

• Symptoms caused by some pelvic support problems may simply be treated with changes in diet, medicine to soften the stool, weight loss, or avoiding strenuous activities.
• Pelvic muscle exercises, also called Kegel exercises, may be recommended.  These exercises, done consistently, have been shown to strengthen pelvic muscles and may help with problems with urination.  A good resource for information and instructions for Kegel exercises is at  http://www.mayoclinic.com/health/kegel-exercises/WO00119
• Some advanced cases of prolapse may require a special plastic or rubber device called a pessary that fits into the vagina to support the uterus, vagina, or bladder.  This can help stop urine leakage from coughing, straining, or exercising.   Pessaries must be removed and cleaned regularly, or they can cause problems in the vagina.  
• In the more severe cases, surgery may be necessary to put the organs back into their proper places. 

Preventing Problems

There are several things you can do to try to prevent pelvic support problems.  They include:

• Maintain a healthy lifestyle with a proper diet and regular exercise.
• Do not smoke.  
• Avoid heavy lifting; if you must lift something heavy, do it properly by bending at the knees, not at the waist.
• Eat a diet high in fiber or take supplements to avoid constipation.

Remember

If you have any symptoms of pelvic support problems, talk to your physician.  If you are diagnosed with a problem, there is a good chance that it can be managed or treated so that you don’t have to live with the symptoms.