Pelvic Organ Prolapse/Cystocele (Bladder Prolapse or Anterior Vaginal Wall Prolapse)/Rectocele (Posterior Vaginal Wall Prolapse)/Uterine Prolapse
The pelvic floor muscles and the fascial system (connective tissue) both support the organs within the pelvic cavity (the bladder, the uterus and the rectum). When the pelvic floor and the fascia have been damaged, one or a combination of the pelvic organs can descend into the vagina. The prolapse can descend to various levels within the vaginal canal, and can bulge or protrude out of the vagina.
Risk factors for developing prolapse include pregnancy, vaginal delivery, aging, menopause, chronic straining/constipation, chronic coughing, being overweight, connective tissue genetic factors, and high impact activities.
If the bladder or uterus has dropped, symptoms usually include vaginal pressure or heaviness or ache. Some women may feel incompletely empty after urinating. There may also be low back pain associated with prolapse. Symptoms are usually worse when against gravity (e.g. standing), with impact activities, when lifting and carrying, and can be worse at the end of the day.
If the back vaginal wall has prolapsed (rectocele), symptoms usually include rectal heaviness or pressure as well as difficulty initiating bowel movements or feeling incompletely empty after bowel movements.
One treatment option for prolapse is physiotherapy supervised pelvic floor muscle exercises (based on verbal and written instruction alone, 75% of symptomatic women are doing pelvic floor exercises incorrectly1). Assessment and treatment may include vaginal and/or rectal exam, Real-Time Ultrasound Imaging, and EMG biofeedback. Properly performed pelvic floor exercises have been proven to either reduce or eliminate the bothersome symptoms of prolapse as well as improve the resting position of the prolapse itself2,3. Other options for managing prolapse include a pessary (a medical device inserted into the vagina to provide structural support) and surgery. Even if a pessary or surgery is desired or required to manage prolapse, pelvic floor exercises can improve the muscular support of the organs and can help
maintain the benefits of surgery and decrease the recurrence of the prolapse after surgery.
It is very important that the pelvic floor has enough strength and endurance to support the organs in tasks of daily living as well as in your occupation and exercise choices. Prolapse can get worse over time if not properly supported by the pelvic floor muscles.
1 Int Urogynecol J Pelvic Floor Dysfunct. 2009 Jul;20(7):843-6. Epub 2009 Mar 10. Moen MD et al.
2 Am J Obstet Gynecol. 2010 Apr 30. Brækken IH et al.
3 Obstet Gynecol. 2010 Feb;115(2 Pt 1):317-24. Braekken IH et al.