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Treatment can help women whose pelvic floor muscles weaken.

The pelvic floor is a group of muscles, ligaments and connective tissue at the bottom of a woman's pelvis. It forms a sort of sling or hammock that helps keep the pelvic organs in place.

According to the National Institutes of Health (NIH), these muscles or tissues sometimes become weakened and can't support the pelvic organs. When this happens, the organs can drop downward. This is known as pelvic organ prolapse.

What can happen?

Weakened pelvic floor muscles can result from being pregnant, especially if the woman has a vaginal delivery. Muscles can also weaken as a result of pelvic surgery. Older women and those who are overweight or obese also are at increased risk for pelvic prolapse.

The American College of Obstetricians and Gynecologists lists these types of pelvic organ prolapse:

• Uterine prolapse—the uterus drops into the vagina.
• Vaginal vault prolapse—the top of the vagina drops down inside the lower part.
• Cystocele—the bladder drops into the vagina. 
• Enterocele—the small intestine pushes against the back wall of the vagina. Enterocele often happens along with vaginal vault prolapse.
• Rectocele—the rectum bulges into or out of the vagina.

In severe cases, the vagina can turn inside out and even protrude outside the body. Other pelvic organs may also drop outside of the vaginal opening.

Symptoms

Severe pelvic prolapse may cause easily identified symptoms, such as organs bulging out of the vagina. According to the college, women with pelvic organ prolapse may also have these less obvious symptoms:

• A feeling of pressure in the pelvic area. This may be worse with lifting or coughing.
• An aching or pulling feeling in the lower abdomen or pelvis.
• Lower back pain.
• A bulge inside the vagina or difficulty inserting tampons.
• Difficulty having a bowel movement.
• Urinary incontinence (leaking urine).

Treatment

Many women with pelvic prolapse don't have symptoms and don't require treatment. In other cases, lifestyle changes—such as losing weight or eating more fiber to avoid constipation and the need to strain during a bowel movement—can help relieve symptoms.

The college and other experts list these additional treatments for pelvic organ prolapse:

• Doing Kegel exercises to strengthen the pelvic floor muscles.
• Taking medication such as laxatives or stool softeners.
• Using a device called a pessary, which is inserted into the vagina to support the pelvic organs. A pessary must be fitted by a doctor and can be worn for many days to weeks at a time.
• Bladder training. This involves emptying the bladder at scheduled times to help with incontinence.
• Surgery. There are several procedures that aim to restore the normal anatomy of the pelvic organs. For example, the weakened area may be sutured to nearby healthy tissue to strengthen it. A graft made of synthetic mesh may also be used to hold up the prolapsed organs.

Many women do well after surgery for pelvic floor prolapse. However, prolapse can recur after surgery. And, according to the NIH, some women who have mesh grafts have serious side effects, such as major bleeding or perforation of the mesh into the bladder or bowel.

If you have pelvic floor prolapse, your doctor will help you choose the treatment that is best for you.

Reviewed 10/2/2023