One or more of the organs inside your pelvis can fall from their original positions. Ligaments, muscles, and connective tissue normally hold your bladder, rectum, uterus, and other organs in their proper places in your pelvis. When these tissues become weak, a problem with pelvic support may result. Weak support can cause one or more of the pelvic organs to drop down into or out of the vagina.

The main types of pelvic support problems include:

• Cystocele: When the bladder drops into your vagina.
• Enterocele: When your small intestine drops into your vagina.
• Rectocele: When your rectum bulges into the vaginal wall.
• Uterine prolapse: When your uterus drops into your vagina.
• Vaginal prolapse: When the top part of the vagina begins to droop (usually after a hysterectomy).

Pelvic support problems can be caused by many conditions. Your problem may begin after childbirth, especially if you had a large baby. After menopause there are changes in the vaginal walls resulting from a decrease in estrogen. When there is less estrogen, the vaginal walls weaken and the bladder may shift from its normal position. As women get older, the loss of muscle tone and the relaxation of muscles may cause the uterus or other organs to drop. Being overweight, chronic straining (such as with constipation), heavy lifting, and constant coughing can also contribute to prolapse problems.

Symptoms can include:

• Feeling of fullness or pressure in your pelvis
• Sense that a “ball” or “lump” is protruding from the vagina
• Problems passing urine or having a bowel movement
• Urine leakage when you cough, laugh or sneeze
• Pain or pressure in your low back
• Problems having sexual intercourse

If you suspect that you may have a prolapse problem, see your health care provider. A simple pelvic examination will diagnose your problem.

Nonsurgical treatment includes wearing a pessary device to support the prolapsed organ or organs, kegel exercises to strengthen the pelvic floor muscles, changes in diet, medicine to soften stool, weight loss, avoiding strenuous exercise, and Physical Therapy. In more severe prolapse, surgery may be needed to put the organs back into their proper place.

3/6/2009