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Uterine And Bladder Prolapse

What Is It? & Symptoms

Monday, Aug. 27, 2007; 7:47 PM

Copyright Harvard Health Publications 2007

What Is It?

Table of Contents

The uterus and the bladder are held in their normal positions just above the inside end of the vagina by a "hammock" made up of supportive muscles and ligaments. Wear and tear on these supportive structures in the pelvis can allow the bottom of the uterus, the floor of the bladder or both to sag through the muscle and ligament layers. When this occurs, the uterus or bladder can create a bulge into the vagina. In severe cases, it is possible for the sagging uterus or bladder to work its way down far enough that the bulge can appear at the vagina's opening or even protrude from the opening. When the uterus sags downward, it is called uterine prolapse. When the bladder sags, it is called bladder prolapse, also known as a cystocele.

Various stresses can cause the pelvic muscles and ligaments to weaken and lead to uterine or bladder prolapse. The most significant stress on these muscles and ligaments is childbirth. Women who have had multiple pregnancies and vaginal delivery are more likely to develop prolapse. Other stresses that can lead to prolapse include constipation with a habit of frequent straining to pass stool and a chronic cough. Obesity also can strain the pelvic muscles. Support problems in the pelvis become worse after menopause because the pelvic tissues depend on estrogen to help them keep their tone, and estrogen levels drop after menopause.

Some doctors estimate that half of all women have some degree of uterine or bladder prolapse in the years following childbirth. For most women, these conditions remain undiagnosed and untreated. Only 10% to 20% of women with pelvic prolapse seek medical evaluation for symptoms.

Symptoms

Mild cases of bladder or uterine prolapse ususally don't cause any symptoms. A prolapse that is more advanced can cause any of the following symptoms:

  • Discomfort in the vagina, pelvis, lower abdomen, groin or lower back - The discomfort associated with prolapse often is described as a pulling or aching sensation. It can be worse during sexual intercourse or menstruation.

  • Heaviness or pressure in the vaginal area - Some women feel like something is about to fall out of the vagina.

  • Leakage of urine, which can be worse with heavy lifting, coughing, laughing or sneezing.

  • Frequent urination or a frequent urge to urinate

  • Frequent urinary tract infections, because the bladder can't empty completely when you urinate

  • A need to push your fingers into your vagina, into your rectum, or against the skin near your vagina to empty your bladder or have a bowel movement

  • Difficulty having a bowel movement

  • Pain with sexual intercourse, urine leakage during sex, or an inability to have an orgasm

  • A bulge of moist pink tissue from the vagina - This exposed tissue may be irritated and cause itching or small sores that can bleed.

  • Moist discharge that soils your undergarments

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