What is Urodynamic Testing?

Something is falling out!

What is Pelvic Organ Prolapse?

Pelvic organ prolapse usually means bulging, sagging or falling of the female organs from the normal position. The female organs are located in the lower pelvic area and are “cradled” by a specialized set of supportive muscles and ligaments. This set of support muscles and ligaments are sometimes called the “pelvic floor”. While standing upright, the bladder is normally located closest to your pubic bone, in front of the vagina. The uterus is suspended at the top of the vagina by a series of strong connective tissue ligaments that hold the upper vagina, cervix and uterus in proper position. The rectum is located closest to your tail bone and behind the vagina. When the pelvic muscles become weak or damaged, the connective tissue ligaments “break” and can no longer support the pelvic organs, relaxation or prolapse may occur. It is similar to a hernia. Organs such as the bladder, uterus, small intestine, and rectum can slip through these connective tissue “breaks”, causing the vagina to bulge down and out of the body. Prolapse of the uterus through these connective tissue “breaks” is never corrected by hysterectomy (removal of the uterus) alone. You certainly would not want your bladder or rectum removed when these organs prolapse through these connective tissue “breaks”. Pelvic organ prolapse is not caused by problems with these organs. Pelvic organ prolapse is a result of a loss of vaginal support as a consequence of pelvic floor muscle and ligament damage.

Prolapse varies in position and severity. You may notice a slight bulging or the sensation of movement in your vagina especially when you cough or bear down to have a bowel movement, or you may have difficulty keeping in a tampon. In more serious cases, you may see a bulge coming out of your vagina, between your legs. Many women react with fear and dread, believing they must have a giant tumor or something terribly wrong. Rest assured that any new bulge or prolapse that you detect is not related to cancer. Although prolapse is not life threatening, it may cause discomfort and distress. A visit to your gynecologist or urogynecologist is required to diagnose exactly what is going on with your pelvic organs.

What causes prolapse?

Many factors that appear to contribute to prolapse are beyond your control. Genetics (the composition and strength of your tissues), number of and events surrounding vaginal deliveries, obesity, chronic coughing, chronic straining to have a bowel movement, and repeated heavy lifting are all conditions that seem to be associated with prolapse. Damage to the pelvic floor muscle and ligaments may also occur as the result of abdominal straining during vaginal delivery. The risk increases with multiple pregnancies, big babies, the use of forceps during delivery, and episiotomies. Chronic coughing from conditions such as smoking, asthma or emphysema place repeated pressure on the pelvic muscles and may cause damage. Prior hysterectomy may also increase the chances of developing prolapse. Age-related changes in hormonal status or muscle wasting may be enough to cause already compromised muscles and ligaments to fail, leading to prolapse. Studies are ongoing to obtain a better understanding of why some women develop prolapse and others do not.

What are the symptoms of prolapse?

The symptoms of prolapse may be subtle and vary depending on the type and severity of the prolapse. Women may complain of pelvic pressure or feeling like “something is falling out”. Symptoms that seem worse at the end of the day, after you have been on your feet for long periods of time, and improve when you get off your feet are likely attributed to pelvic organ prolapse. As previously mentioned, you may have difficulty wearing a tampon.

The prolapse may be acting like a “plug”, partially blocking urine or stool until you change positions or the prolapse moves for some reason. Women report difficulty emptying their bladders, urinary frequency, urgency, and occasional urge incontinence as a result of this “plugging” effect. Some women may experience discomfort or pain during intercourse as a result of the prolapse. As the relaxation progresses, you may notice vaginal dryness, irritation, bleeding, or pain because these sensitive tissues can rub against your legs or clothing. Women sometimes describe prolapse as feeling like they are sitting on a ball.

You may feel like your rectum has stool remaining in it after a bowel movement. You may have increasing difficulty pushing out this trapped stool over time. As a result, you may have some soiling of your underwear when some fecal material seeps around “trapped” stool past the relaxed portion of the anus after you felt you were finished in the bathroom. “Trapped” stool or urine may come out during vaginal intercourse.

Some women may resort to pushing up their prolapse to empty their bladder or rectum when symptoms become severe. This activity is called “stenting”.

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