Pelvic relaxation is weakness or laxity in the supporting structures of the pelvic region. Bladder, urethral, rectal, or uterine tissue may then bulge into or out of the vagina. This is called pelvic organ prolapse. It’s not a dangerous condition, and it doesn’t necessarily worsen over time, but it can drastically affect a woman’s quality of life by causing discomfort and embarrassment and limiting sexual and physical activity.
Pelvic organ prolapse was once rarely recognized, and discussed when it was recognized. But today it has become a priority because women are living longer and want to stay active. Many primary care clinicians and gynecologists routinely screen women for symptoms, and a surgical subspecialty called urogynecology has arisen to correct prolapse conditions and urinary incontinence that often results.
What may be causing it?
Support for the pelvic organs comes from pelvic floor muscles and connective tissue called fascia, including thickened pieces of fascia that from ligaments. When pelvic floor muscles are weakened, the fascia and ligaments must bear a greater burden. Eventually, they can stretch and fail, allowing organs to drop and bulge into weak points in the vaginal wall.
A cystocele occurs when the back of the bladder protrudes into the front wall of the vagina; a urethrocele, when the urethra presses into the vagina wall; a rectocele, when rectal tissue bulges into the of the wall of the vaginal and uterine prolapse, when the uterus drops down into the vagina. A woman often has more than one type of prolapse. The severity of the problem depends on how amount of tissue has descended into the vagina. In stage 4 prolapse, the most severe kind, the prolapsed organ is visible outside the vaginal opening.
- Giving birth vaginally
- Surgery to the pelvic floor
- Connective tissue disorders
Managing mild prolapse
If you have no or few symptoms, you probably don’t need treatment, but you should try to make sure the condition doesn’t worsen. Lose weight if you’re overweight or obese. Avoid anything that increases pressure within the abdomen, including lifting heavy objects, constipation, and coughing. And don’t smoke – smoking causes coughing. If you’re experiencing major discomfort or inconvenience, surgery is the only definitive solution. For less troubling symptoms – or if you want to delay or avoid surgery – try this:
Pelvic floor strengthening
Contracting and releasing the pelvic floor muscles ( Kegel exercises) can help relieve mild cystocele, urethrocele, and rectocele and possibly stop their progression. A 2011 study found that women with prolapse who performed daily pelvic floor exercises for six months reduced the severity of their symptoms and their prolapse, compared with a control group that didn’t do these exercises. Ask your clinician for instructions on how to perform pelvic floor exercises, or request a referral to physical therapist or other practitioner who can provide instructions.