The normal position of the uterus and bladder is just above the inside end of the vagina and are supported by muscles and ligaments sometimes called a “hammock”. When the pelvic floor muscles and ligaments weaken and no longer provide adequate support, they can move down into the vaginal canal causing a uterine prolapse or a bladder prolapse (also called a cystocele).
Post-menopausal women who have had at least one vaginal delivery are most often affected by uterine prolapse. Damage to supportive tissues during pregnancy and childbirth along with gravity, loss of estrogen and repeated straining can weaken pelvic floor muscles.
What are the symptoms of a prolapse?
Mild cases of bladder or uterine prolapse usually don’t cause any symptoms. It’s important to make an appointment with our office when symptoms first start to bother you. Don’t wait until your discomfort becomes severe. Regular pelvic exams can help detect uterine prolapse in its early stages.
A prolapse that is more advanced can cause any of the following symptoms:
- Feeling of heaviness in the pelvis
- Low back pain
- Pain during intercourse
- Problems putting in tampons or vaginal applicators
- Need to urinate often or urgently, urine leakage, incomplete emptying of the bladder
- Frequent urinary tract infections (Bladder Prolapse also called a cystocele)
How is a prolapse diagnosed?
At your appointment we’ll do a medical history and a physical exam to help determine if you have a prolapsed uterus. If you also have urinary incontinence or feel like you can’t empty your bladder, we may do a procedure called a cystoscopy to look at your bladder and urethra. Other tests to confirm your diagnosis also may be ordered.
How is a uterine prolapse treated?
- Lifestyle changes such as losing weight may help.
- Kegel exercises can strengthen your pelvic floor muscles. To do this exercise, you squeeze the muscles you use to control the flow of urine, and hold for up to 8 to 10 seconds then release. You repeat this 8 to 12 times, 3 times a day. Try to do these exercises every day but at least 3 to 4 times per week.
- A pessary can be inserted into your vagina to support your pelvic organs also ease symptoms.
- Surgery to rebuild the area is another option.
How is a bladder prolapse (cystocele) treated?
A cystocele is caused when the wall between the bladder and the vagina weakens causing the bladder to drop or sag into the vagina. Treatment depends on how far the bladder has dropped into the vagina and may include:
- Activity changes. Avoiding certain activities, such as heavy lifting or straining during bowel movements, that could cause the cystocele to worsen.
- Kegel exercises. Regular, daily exercises of the pelvic muscles to make them stronger.
- Pessary. This is a device placed in the vagina to hold the bladder in place.
- Surgery. May be used to move the bladder back into a more normal position
- Hormone replacement therapy. This may help to strengthen the muscles around the vagina and bladder. If you are thinking about hormone replacement therapy, talk to us about the risks and benefits first.