Female Pelvic Prolapse

Female pelvic prolapse occurs when your pelvic floor is too weak to keep your organs in place. Your pelvic floor is the combination of muscles, tissues and ligaments that support your vagina, uterus, bladder and rectum.

With mild female pelvic prolapse, one or more of your pelvic organs may drop. In more severe cases, your pelvic organs can pass through the opening of your vagina.

Types of Female Pelvic Prolapse

There are several types of female pelvic prolapse. The type you develop depends on which pelvic muscles are weak and which organs are affected.

• Dropped bladder (cystocele): Weak vaginal muscles let your bladder drop, creating a bulge. Stress incontinence (urine leakage) can happen when you sneeze, cough or laugh.
• Dropped rectum (rectocele): The front wall of your rectum drops into your vagina and creates a bulge. You may notice the bulge more during bowel movements.
• Dropped uterus: Weak pelvic muscles let your uterus fall into your vaginal canal. Women who have gone through menopause are most at risk. Their lower estrogen levels make muscles weaker.
• Vaginal vault prolapse (enterocele): Your intestines press down on the top of your vagina. They can potentially fall into your vaginal canal. This type of prolapse can cause urine leakage. It also frequently happens after a hysterectomy (removal of your uterus).

Symptoms of Female Pelvic Prolapse

Female pelvic prolapse can cause a variety of uncomfortable symptoms. Signs of prolapse can include:

• Aching in your lower back.
• Bulge or fullness in your vagina.
• Bulge or pressure that gets worse during the day.
• Bulge or pressure that worsens when you cough or stand too long.
• Fullness or pressure in your pelvis.
• Not being able to keep in a tampon.
• Pressure or pain during sex.
• Problems with urination.
• Vaginal spotting (bleeding).

Bladder and bowel changes can also happen. You may need to urinate more. But you may not be able to empty your bladder all the way. You may also need to press on — and move — bulging organs to be able to have a bowel movement.

Causes of Female Pelvic Prolapse

There are several reasons why the muscles in your pelvis may lose their strength.

• Age: Your muscles naturally lose strength as you get older. During menopause, you produce less of the female hormone estrogen. Lower estrogen levels cause the tissues that support your pelvic floor to weaken.
• Family history: Having family members with this condition can increase your risk.
• Overweight: Being overweight or obese can increase your risk.
• Straining: Constant straining increases pressure in your abdomen and weakens your muscles. This can happen with ongoing constipation, chronic coughing or frequent heavy lifting.
• Vaginal birth: This is the most common female pelvic prolapse cause. The more babies you have vaginally, the weaker your muscles can become.

Diagnosing Female Pelvic Prolapse

Our urologists will complete a full assessment to diagnose your female pelvic prolapse. They will talk with you about your medical history and examine your pelvic organs.

Additional tests for prolapse may include:

• Bladder function test: Urination problems are common with female pelvic prolapse. Our urologists can perform two tests to identify any issues. A urodynamics test reveals how well your bladder and urethra hold and release urine. A cystoscopy lets your doctor examine the inside of your bladder and urethra.
• Imaging: Ultrasound and MRI scans show our urologists how far your abdominal organs have dropped.
• Pelvic floor strength tests: These tests measure the strength of the muscles that support your bladder, rectum, urethra, uterus and vagina.

Preventing Female Pelvic Prolapse

Preventing female pelvic prolapse isn’t always possible. You cannot control many causes. But you can reduce your risk with these healthy habits:

• Avoid constipation
• Be careful with heavy lifting (squat to lift — don’t bend from your waist.)
• Don’t smoke
• Maintain a healthy weight
• Practice daily pelvic floor exercises

At Emory Healthcare Urology Services, we are known for our compassionate, patient-centered approach to delivering high-quality care for difficult-to-discuss problems. Our award-winning fellowship-trained specialists in female pelvic medicine and reconstructive surgery (FPMRS) provide the most innovative treatments and leading-edge procedures. And we are dedicated to developing the next generation of research-based therapies that will improve the quality of life for our patients.