Your Pelvic Floor and Prolapse

When your pelvic organs shift to a lower position, it is known as prolapse. It can involve your bladder, bowel, uterus, or a combination, and can happen when the structures supporting your pelvic organs are weakened.

When your bladder support is affected it is called a cystocele. This can negatively affect your bladder function, including making it hard to hold urine or hard to empty urine. Similarly, when your bowel support is affected, it is called a rectocele. This can negatively affect your bowel function, resulting in difficulty passing stool or leakage of stool. When your uterus support is affected, it is known as uterine prolapse. This can cause vaginal heaviness and pressure on your bladder and bowel, bleeding and significant discomfort with sitting or exercise.  

Prolapse often affects multiple organs which is why the general term pelvic organ prolapse is more commonly used and may result in many different types of symptoms.  It can also have a negative impact on sexual function, resulting in pain with sex, decreased sensation, or lack of sex drive.

Many women with prolapse have absolutely no symptoms.  Most women have minor forms of prolapse which may not cause any discomfort or affect function, and may not progress, but for some women prolapse may become bothersome.

There are 4 different ways to treat pelvic organ prolapse:

1. Expectant management is the term used when no treatment is done. This is the best choice for women who have no symptoms.

2. Pelvic Health Physiotherapy is one of the non-surgical treatments for pelvic organ prolapse. Well-functioning pelvic floor muscles can reduce the symptoms of prolapse, slow down progression, and may lead to improvement in some of the pressure symptoms.

3. Another non-surgical option is a pessary, which is a device that is placed into your vagina to provide support to your vaginal tissues. It works for all types of prolapse. Some pessaries also work for certain types of urine leakage.

4. Finally, there is surgery, which is the most invasive treatment. Surgery for prolapse usually works well, but like all surgery, it comes with the possibility of complications. The durability of the repair is often less than perfect, which means the prolapse can return with symptoms in the future. In fact, the need for repeat surgery for pelvic organ prolapse is significant. Some women have hysterectomies because they have prolapse of the uterus, but hysterectomy alone does not fix prolapse. The top of the vagina needs to be suspended, so it does not fall out after the uterus is removed.

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