The uterus, bladder, and rectum near the vaginal canal can push through (prolapse) into this canal. A bulging uterus is called uterine prolapse. A bladder prolapse is a cystocele. A prolapsed rectum is a rectocele. The prolapsed organ can cause tissue to bulge out of the vagina. Women may first notice something like a ball of tissue coming out of the vagina. Most rectoceles occur in women. Rarely, men may have rectoceles.
The most common cause is childbirth because it stretches muscles that support pelvic organs. Normal aging and menopause (change of life) contribute to prolapse. Levels of estrogen, which strengthen muscles near the bladder, rectum, and vagina, decrease with menopause. Being overweight, lifting heavy objects, having long-lasting cough, straining during bowel movements (from constipation), and cancers also cause prolapses.
Mild or moderate prolapses may cause pelvic pressure, low backache, pain, or feeling that something is falling out. Urine may leak, especially with coughing, sneezing, or laughing. Rectoceles can cause bowel movement problems.
Severe prolapses also cause a feeling of fullness in the abdomen (belly) or a bulge that may go away when lying down. Other symptoms are problems emptying the bladder or having bowel movements, pelvic pain, abdominal discomfort, urgent or painful urination, and problems during sex.
The health care provider will make a diagnosis from a physical examination, including a pelvic exam. To help diagnose prolapse your health care provider may ask you to strain (i.e., push as if you’re trying to pass stool or urinate). Urine and blood tests may be done. Ultrasonography and voiding cystogram (cystourethrogram) may also be done. The cystogram is an x-ray taken during urination to show bladder shape.
More severe prolapses with pelvic organ bulges need treatment. Mild to moderate prolapses (no organ bulges) and no symptoms need no treatment, just watching. Straining during bowel movements, heavy lifting, coughing, and constipation should be avoided. Eating high-fiber foods can help constipation. Kegel exercises involve tightening pelvic floor muscles and can help symptoms. These exercises strengthen muscles supporting the bladder and vagina. If Kegel exercises don’t help, physical therapy (biofeedback, electrical stimulation) may. If all these treatments don’t work, a pessary (plastic or rubber ring fitted into the vagina) can hold the bladder in place. Women after menopause may take hormone replacement therapy to help strengthen muscles. Surgery can be done when the pessary doesn’t fit properly or if there is more than one prolapsed organ. Surgery may hold the bladder in the correct position.
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