The Association of Minimally Invasive Gynecologic Surgeons
…dedicated to safe, state-of-the-art surgery and health life-styles for women of all ages
R. Wayne Whitted MD, MPH
Paul A. Pietro MD
740 N Kendall Dr. Suite 101
Miami, Florida 33176
Phone: 305-596-3744
Pelvic Support Problems
Many women's pelvic organs change as they age. They may have a feeling of
pelvic pressure or heaviness. It may feel like "something is falling out of the
vagina." These symptoms may be caused by pelvic support problems.
Although these problems may begin with childbirth, women may notice them
even more as they age.
The Pelvic Organs
The parts of the body affected by pelvic support problems include the urethra
and bladder, the small intestine, the rectum, the uterus and the vagina.
The pelvic organs are held in place by three types of support:
1. Layers of connecting tissue called endopelvic fascia
2. Thickened parts of the fascia called ligaments
3. A paired group of muscles that lies on either side and around the
openings of the urethra, vagina and rectum
When the tissues that support the pelvic organs are stretched and damaged,
the organ that they support may drop down and press against the wall of the
vagina. This causes a bulge.
The main causes of pelvic support problems are pregnancy and childbirth.
However, pelvic support problems can occur in women who have never had
The symptoms of pelvic support problems depend on which organs are
involved. They can cause minor discomfort or major problems in the way the
organs work. Symptoms include:
Feeling of pelvic heaviness or fullness, or as though something is
falling out of the vagina
Pulling or aching feeling in the lower abdomen or pelvis
Leakage of urine or problems having a bowel movement
In severe cases, the pelvic organs may bulge into the vagina. This bulge may
stick out of the vaginal opening, where it may be seen with a mirror or felt
with the fingers.
In some cases, the uterus may stick out through the vaginal opening.
Types of Pelvic Support Problems
The main types of pelvic support problems and the pelvic organ that can
cause bulging are as follows:
Cystocele — bladder
Vaginal vault prolapse with enterocele — vagina and small intestine
Rectocele — rectum
Uterine prolapse — uterus
A cystocele, sometimes called anterior wall prolapse, occurs when the bladder
drops from its normal place into the vagina. Some cystoceles cause urine to
leak when you cough, sneeze, lift objects or walk.
Small cystoceles are common. In most cases, they do not cause problems
with urination and do not need surgery. If a cystocele is causing symptoms,
your doctor can suggest ways to relieve them.
Vaginal Vault Prolapse With Enterocele
Sometimes after hysterectomy (removal of the uterus), the top of the vagina
loses its support and drops. This is called vaginal vault prolapse. The degree
of prolapse varies. The top of the vagina may drop part of the way into the
vagina and remain there, or it may extend part or all of the way through the
vaginal opening.
When the rectum bulges into or out of the vagina, it is called a rectocele. It is
sometimes called a posterior wall prolapse. A large rectocele may make it
hard to have a bowel movement, especially if you are constipated.
Uterine Prolapse
When the uterus drops down into the vagina, it is called uterine prolapse. Mild
degrees of prolapse are common. They often do not cause symptoms and do
not need surgery.
Women with more severe forms of this condition often will have a feeling of
pelvic pressure or a pulling feeling in the vagina or lower back. The cervix (the
opening of the uterus) may stick out from the vagina. This may cause
discomfort or problems with sex.
Proper diagnosis is key to treating pelvic support problems. However,
diagnosis is not always simple because the symptoms of pelvic support
problems often are the same as those of other conditions. The exact cause of
the problem must be found before the best treatment can be given.
Many women do not need treatment. Some women find symptoms are
relieved by exercising, making changes in their diet, keeping their weight
under control, not smoking, and avoiding heavy lifting and straining.
Medication or use of a device called a pessary also may be helpful. Pelvic
support problems sometimes may be treated by surgery.
Special Exercises
Exercises called Kegel exercises, or pelvic muscle exercises, are used to
strengthen the muscles that surround the openings of the urethra, vagina and
You should cut down on caffeine, which acts as a diuretic. Caffeine can be
found in coffee, tea and soft drinks. A high-fiber diet may help bowel function
and prevent constipation.
There are special medicines that help treat urinary and bowel symptoms.
Vaginal Pessaries
A pessary may be inserted into the vagina to support the pelvic organs. When
a pessary is used, it must be removed, cleaned and reinserted on a regular
Surgical Repair
Pelvic support problems may be corrected by surgery. The surgery can be
done through the vagina or abdomen based on your type of support problem.
Finally ...
Many women have pelvic support problems. If you have any symptoms, talk
to your doctor about them. The right diagnosis and treatment can offer relief.
This excerpt from ACOG's Patient Education Pamphlet is provided for your
information. It is not medical advice and should not be relied upon as a
substitute for visiting your doctor. If you need medical care, have any
questions, or wish to receive the full text of this Patient Education Pamphlet,
please contact your obstetrician-gynecologist.
To ensure the information is current and accurate, ACOG titles are reviewed
every 18 months.
Copyright © April 2004 The American College of Obstetricians and Gynecologists