Pelvic Floor Weakness/Prolapse

Pelvic floor weakness or prolapse occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal, or even outside of the vaginal opening.

Types of pelvic floor prolapse:

• Bladder (cystocele): A hernia-like disorder that occurs when the wall between the bladder and the vagina weakens, causing the back wall of the bladder to bulge into the vagina.
• Rectum (rectocele): A hernia-like disorder in which the wall between the rectum and the vagina weakens, causing the front wall of the rectum to push into the vagina.
• Small bowel (enterocele): A hernia-like disorder, occurring in women who have had hysterectomies, in which the small bowel protrudes into the top of the vagina.
• Uterus (uterine prolapse): A condition that occurs when the uterus droops into the vagina and starts to drop through the vaginal opening.

Common factors that may cause a pelvic floor prolapse include:

• Childbirth (especially multiple births)
• Menopause
• Hysterectomy
• Advanced age
• Obesity

The symptoms associated with a pelvic floor prolapse depend on the type of the prolapse condition. But the most common sign of them is the sensation that tissues or structures in the vagina are out of place. The following are general symptoms of all types of pelvic floor prolapse:

• Pressure or fullness in the vagina or pelvis
• Painful intercourse (dyspareunia)
• Recurrent urinary tract infections
• Difficulty emptying the bowel and/or bladder
• Constipation
• Urinary stress incontinence
• Pain that increases during long periods of standing
• A lump or protrusions of tissue at the opening of the vagina

Surgery is the only way to fully correct most worsening pelvic floor prolapses. The severity of the prolapse, whether the woman is sexually active, and her treatment preference all factor into this decision.

Nonsurgical treatments:

• Activity modification: The physician may recommend activity modification such as avoiding heavy lifting or straining.
• Pessary: A small plastic or silicone medical device provides support for the vagina.
• Pelvic floor exercises: Kegel (pelvic squeezing) exercises help strengthen the muscles. It involves repeatedly tightening, holding and then relaxing the muscles – up to three sets of 10 a day​.
• Estrogen replacement therapy: Estrogen helps strengthen and maintain muscles in the vagina.

Surgical treatments:

• Abdominal surgery using mesh: In this procedure, the mesh pulls the vagina up to the sacrum (called a sacrocolpopexy). Only available for women who have had hysterectomies, abdominal surgery is considered the “gold standard” for prolapse surgery. However, the surgery requires a long post-operative recovery and raises risks of intra-abdominal injuries, or bowel injury. The FDA warning about mesh does not apply to this procedure.
• Vaginal surgery without mesh: This treatment involves repair with either a suture or with biological material, such as pigskin. These repairs don’t always hold up over time.