The uterus, bladder and rectum are all located around the vaginal canal. Because of the way these organs are arranged, it is possible for them to herniate or bulge into the vaginal canal when supportive tissues in the pelvic region become weak. Such bulges are called prolapse.
Prolapse can lead to discomfort and heaviness in the vagina, difficulties using the toilet or the unwanted leakage of urine (called urinary incontinence). When a prolapse is large, tissue may even be seen hanging outside the vagina.
Types of Prolapse
The uterus drops in the vaginal canal.
The front wall of the vagina sags and causes the bladder to drop.
The back wall of the vagina pouches forward, causing the rectum or the intestines to bulge into the vagina.
Vaginal vault prolapse
The vaginal walls sag after a patient has a hysterectomy.
What Causes Prolapse
- Childbirth, which can injure supportive structures in the pelvis
- Chronic coughing, chronic constipation and heavy lifting, which can cause straining of the abdominal muscles
- Menopause, which causes estrogen levels to decrease and, as a result, weaken pelvic tissues
- Normal aging
Why do Kegels?
Kegel exercises help to strengthen the muscles that support the vagina, uterus, bladder and rectum. Greater support can be helpful in several ways:
- Prolapse may disappear or be less pronounced
- Kegels can help improve stress incontinence, the unwanted leakage of urine that occurs with coughing, sneezing, lifting and standing
- Sexual enjoyment may increase
How are Kegels done?
1. First, locate your pubococcygeus (PC) muscle in your pelvic floor.
- Do this by trying to stop the flow of urine when you urinate. If you can successfully stop the flow, then you have correctly located your PC muscle
- Alternatively, you can learn to exercise your PC muscle by:
Women: inserting two fingers in your vagina and tightening your vaginal muscles around your fingers
Men: tightening the muscles at the base of the penis or tightening your anal sphincter around a finger
- If you cannot locate your PC muscle, our physical therapy care team can help you begin a Kegel exercise routine. During a visit, we can talk about your Kegel technique, help you locate your PC muscle, or even begin a biofeedback therapy program geared toward helping you find and exercise this muscle.
2. Once you have found your PC muscle:
- Squeeze your PC muscles for 5 seconds
- Then relax for 5 seconds
- Do 10 sets of squeezing, then relaxing
- Repeat these sets 3 times each day
3. Remember to keep your abdominal muscles relaxed while you exercise your PC muscle. The best way to do this is to breathe normally while doing Kegels.
What is biofeedback therapy?
Biofeedback is a learning process where you become more aware of and more able to control your own body’s functioning. In urology and gynecology, biofeedback is typically used to help patients locate and strengthen their pelvic floor pubococcygeus (PC) muscle.
How does biofeedback work?
During biofeedback therapy, special measuring devices are placed in your vagina, rectum or on your skin to monitor your pelvic floor. You are then asked to contract your PC muscle while watching the strength of each contraction on a computer screen. This interactive approach allows you to adjust each squeeze to make it stronger and more effective.
Why is the pubococcygeus (PC) muscle important?
This important muscular sheet helps anchor the urethra, vagina, anus and rectum in their proper anatomic locations. When the PC muscle weakens, these structures are more likely to shift out of place and prolapses may occur in women or urinary incontinence may occur in both men and women.
A pessary is a ring-soft flexible silicone device that can be placed in the vagina to support structures such as the uterus or bladder. Some women find that wearing a pessary can help alleviate the discomfort caused by pelvic organ prolapse. They may also find that they have better bladder control and less urinary incontinence.
A doctor or nurse practitioner can almost always fit a patient with a pessary in one office visit. Pessaries come in various sizes, so it is important to find one that provides good support but also feels comfortable to the patient. Our patients are taught how to remove and clean their pessaries themselves or have their pessary removed and cleaned regularly in the office. Pessaries usually cause very few problems, but an increased chance for developing vaginal irritation, bleeding or infection does exist.
So far, the oral estrogen in HRT has not been reliably shown to provide relief to those suffering from pelvic organ prolapse and urinary incontinence. For this reason, and because oral estrogen has so many potential side effects, we do not recommend starting HRT for the sole purpose of treating these conditions.
However, evidence has clearly demonstrated that vaginal estrogen cream can make skin thicker, softer and more elastic. It can also “plump up” the pelvic floor tissues and help improve vaginal moisture. It also helps prevent urinary tract infections by bringing more blood vessels into the vagina. For this reason, it may be worthwhile to try a topical vaginal cream containing estrogen in the vaginal area.
The decision to have prolapse surgery is an important one that should be made only after receiving all the options and facts from your physician. Ultimately, it is up to you to decide when your quality of life could be improved with surgery.
Vaginal surgeries can also be performed to tighten the vagina and prevent future prolapse in patients who no longer desire sexual activity.