Your pelvic floor is a group of muscles that act like a hammock from your pubic bone to your tailbone. It supports your uterus, bladder, anus and intestines.
It can weaken and stretch during childbirth, or from repeated heavy lifting or chronic coughing. Pelvic organ prolapse may be caused by those factors, or from surgery to remove your uterus (hysterectomy).
Treatment options include pelvic floor exercises and medical devices such as vaginal pessaries. A trained physical therapist can help you coordinate and strengthen these muscles.
The pelvic floor includes muscles, ligaments and connective tissue that support and control your bladder, uterus, vagina and bowel. When these muscles weaken or become stretched, the organs can drop down into the vaginal canal (prolapse). This can cause pain, pressure and urinary and bowel problems. Pelvic floor disorders can also lead to sexual dysfunction and pregnancy complications.
Many treatments can reduce or relieve your symptoms. Your doctor will decide which one is best for you. Your urogynecologist may refer you to a urologist or a specialist in pelvic conditions, such as a gastroenterologist, for more specific evaluation and treatment.
For example, if your anal prolapse is causing fecal incontinence, your doctor can repair the anal sphincter using advanced techniques that restore normal function. This surgery can be done through your vagina or abdomen (laparoscopic) to avoid scarring and shorten your recovery time. Surgery can also help people with rectal prolapse or multi-organ pelvic prolapse. Surgical repair involves lifting and supporting your pelvic organs. Your surgeon can stitch the tissues in your lower belly or use a synthetic sling to hold your organs in place.
The muscles that form your pelvic floor control the bladder and bowels in men and women, as well as the uterus (for women). They also hold your organs and other tissues inside the pelvis.
The pelvic floor can be weakened or damaged by many factors, including childbirth, heavy lifting, chronic disease, or surgery. Over time, these problems can lead to pelvic organ prolapse.
A physical exam can help evaluate your pelvic floor. Your doctor will ask about your past health, symptoms and family history. They will then perform a physical exam, which includes tests to check the strength of your pelvic floor and sphincter muscles.
Your doctor may want to use an imaging test, such as magnetic resonance imaging or ultrasound, to get a more detailed picture of your pelvis. However, these tests may be harmful if you have a prolapse in your brain or spinal cord, as the radiation could damage those areas. You should wait until your doctor tells you that the prolapse is healed before having these tests. You should also avoid any activities that put pressure on your abdomen until the prolapse is healed, such as carrying heavy loads or engaging in vigorous exercise.
A defecating proctogram is a diagnostic test that assesses anorectal anatomy, function, and structure. It is done by inserting a barium paste into the rectum. Images are obtained at rest, while squeezing and straining, during evacuation, and during postevacuation.
These images can help detect rectoceles (anterior prolapse in females or a posterior bulge in males) that do not empty and internal rectal intussusception or anismus. They can also show how much stool remains in the rectum after evacuation and if the stool was evacuated completely.
A defecating proctogram can confirm a diagnosis of pelvic floor dysfunction in patients with refractory constipation. MRI defecography can also identify structural abnormalities, such as rectoceles that do not empty, that may be responsible for obstructed defecation. However, the sensitivity and specificity of these tests are not well established. The sensitivity of asymptomatic healthy subjects varies and the presence of structural abnormalities does not always correlate with symptoms or with functional changes in the bowel. These tests should be performed only after initial bowel history and physical examination. Defecography may also be useful in assessing the response to a trial of fiber and osmotic laxatives.
Biofeedback is a mind-body technique that can improve pelvic floor function and relieve bladder and bowel dysfunction. This treatment involves using electrical sensors that monitor physiological processes like heart rate, brain waves and muscle tension and then providing you with visual and audio feedback. Using the information, you learn to control involuntary physiological responses.
For example, if you’re working on your pelvic floor muscles to treat urinary incontinence, your nurse places external sensors in the lower abdomen or inserts them into the vaginal or anal canal and then sends a signal to a computer screen that lights up or emits sounds when you tighten or relax the muscles, according to Cleveland Clinic and Mayo Clinic.
The feedback on the screen helps you to see in real time that you are changing your body’s physiological response, explains Mount Sinai. Eventually, you can create these changes without the feedback screen, allowing you to self-regulate your bodily functions that were once considered involuntary, such as your heart rate or blood pressure. Each session usually lasts less than an hour, and most patients see improvement within eight to 10 sessions.
The muscles that line the bottom of your pelvis control your bladder and bowel (or your uterus in women). They keep urine and waste inside until your body is ready to get rid of it. But when these muscles become weak, the organs can drop or prolapse below their normal positions. This can cause pain, pressure in the vagina and urinary or bowel dysfunction.
The good news is that nonsurgical treatments like pelvic floor exercises or a vaginal pessary can often relieve symptoms. But if the problem doesn’t respond to these conservative measures, surgery may be necessary.
There are a number of surgical approaches to prolapse, but most aim to lift the organs that have slipped down and restore support. In sacrocolpopexy and sacrohysteropexy, for example, the top of the vagina is suspended to ligaments over the sacrum or coccyx (tailbone) using straps of permanent medical mesh graft material. Other surgeries are less common, but still help improve prolapse symptoms. Many involve suspending the top of the uterus (womb) to the woman’s own ligaments, but don’t use the mesh graft material. pelvic floor repair