Has Your Anatomy Fallen & Can’t Get Back Up? Common Prolapse Types, Causes & Treatments
The first time I heard of a cystocele was during my 6 week postpartum appointment. My OB commented that I had a “small cystocele” and included that we didn’t need to worry about it until I was in my 40’s and it started causing issues. As an OT I was shocked, baffled and disappointed.
Why? As part of my training and personal interests, I have taken on extra education in the treatment of incontinence and pelvic floor dysfunction and am deeply disappointed with public knowledge and discussion of this important dysfunction impacting over 1/3 of women over 30!
Say it with me. The vagina is a muscle. The pelvic floor can weaken. Strengthening, maintaining and exercising our pelvic floor, vaginal canal and monitoring overall condition is something overlooked and ignored by too many health care practitioners.
Let’s get to it.
The Pelvic Floor is a series of muscles, tendons, ligaments and tissue that hold and support the pelvic organs like a sling. Without this sling our uterus, bladder, intestines etc. would literally fall through the hole in our pelvis. So what happens when it weakens?
Without proper support, the pelvic organs often develop something your practitioner would diagnose as pelvic floor dysfunction. This can include incontinence, pain, pressure, sexual dysfunction and difficulty controlling poop and pee. Pelvic floor weakness can be a series of symptoms and vary from individual to individual.
Included in the Pelvic Floor Anatomy is the vagina. The Vagina is a muscular tube leading from the opening at the vulva to the uterus/cervix. When this muscle weakens, often in conjunction with the pelvic floor, the pelvic organs can dip into the vaginal canal causing prolapses known as a cystocele (bladder prolapse) and a rectocele (rectum prolapse).
Treatments vary and often include pelvic floor exercises & strengthening and sometimes surgery.
To start let’s take a look at a diagram of “normal” anatomy. Let me start by saying that I dislike the word normal. What’s your normal may certainly not be another person’s normal. Size, alignment and even vaginal length to cervix vary from individual to individual. This is an artist’s illustration we collaborated on of the pelvic anatomy in normal alignment without dysfunction so you can see how this image changes from illustration to illustration.
I hired an artist to develop these illustrations for this website because I simply could not find a series like this to use in this article. I found that both disappointing and discouraging that linear education like this just didn’t exist on the web. So here it is!
A Cystocele happens due to a weakening of the front of the vaginal wall, allowing the bladder to bulge into the vagina. This condition changes the angle of the urethra (the tube that carries urine from the bladder to the outside when you pee labeled above) and may or may not result in stress incontinence, or leaking when you cough, sneeze, jump etc. (1)
When a cystocele occurs, a complication may be that the urethra prolapses into the vagina (called urethrocele). When prolapse of both the bladder and the urethra occurs, the condition is called cystourethrocele. (1)
A Cystocele occurs at varying degrees and can be from mild to severe. This is determined by your practitioner and may present as a need to peel often, inadequate peeing, pressure and/or discomfort. (1, 3)
Much like the Cystocele, a Rectocele occurs because of the weakening of the vaginal canal. However, in this case, it’s a weakening of the back of the canal. It may also be referred to as a proctocele and happens when the rectum bulges into the back of the vaginal canal.
This may be more noticeable during a bowel movement and also varies in degree of severity. It may be felt from inside the vaginal canal and also present as pressure, feeling the need to poop or having to poop multiple times per day because it doesn’t all clear at once. (1, 2)
“Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the vagina.” (4)
Like the Cystocele and Rectocele, a Uterine Prolapse occurs at varying levels and is also often due to a weakening of the pelvic anatomy. Perhaps your cervix started up really high but after pregnancy, you can find your cervix very close to the vaginal opening due to the uterus sinking into the vaginal canal. In extreme cases, it comes out of the vaginal canal and can be seen from the vulva.
It may be characterized by heaviness or pulling sensation in the pelvis and vaginal area, feeling like you’re sitting on a ball, continence issues and in more server cases tissue coming out of the vagina & sexual dysfunction. (4)
How do you know if you have one?
For me, the cystocele was something my OB mentioned at my 6-week postpartum appointment. I hadn’t been exploring my vagina and this was news to me!
Some may find that their menstrual cup is falling out, feel the bulge when inserting fingers or other methods of penetration or find the uterine prolapse when they can’t quite get their menstrual cup in as far as they want because of any of these prolapses.
They may or may not have physical discomfort or other signs and symptoms of a weak pelvic floor.
If you noticed in the information above, the word “weakening” is used over and over. The weakening of the vaginal canal, weakening of the pelvic floor, weakening of the supports for the uterus etc. When something is weak…we try to strengthen it.
Strengthening the pelvic floor, vagina and surrounding anatomy can be diagnosed and prescribed individually by your Occupational or Physical Therapist. Most often, a prescription from a doctor is needed to get therapy started.
In some cases, but often not before strengthening is attempted, there are surgical interventions to help with prolapses causing dysfunction and interfering with daily life. (1-4)
The Pelvic Floor muscles are often involved with movements of the hips and core. However, this typically does not directly strengthen the vaginal canal itself. Many people swear by kegel exercisers because they help isolate the muscles to contract and can be purchased and recommended in various weights. Some are even app-enabled and give feedback and track progress!
** This is an informational article. While I am an Occupational Therapist, I am not YOUR Occupational Therapist. Please consult with your physician for diagnosis and treatment of your individual needs.
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