Procedure Education

Condition Education

Prolapse

Support of the female pelvic floor can be modeled after a trampoline. The boney pelvis is the metal frame, the muscles are the springs, and the connective tissue (fascia) is the fabric. The trampoline can sag to the ground because the springs are stretched out, the fabric is stretched or torn, or a combination of the two. prolaspe video

Physical therapy can help improve the muscles (springs), while surgery addresses the stretched or torn connective tissue (fabric). The two approaches compliment each other in gyn surgery the same way they do in orthopaedics.

Viewed from the top female pelvic support can be modeled by a wagon wheel. Again the pelvis is the metal rim. And the center hub is where the uterus sits. The center hub is supported from the rim by the spokes which represent the bladder and rectum support. When viewed from the side, think of a suburban mailbox. The mail door is the vaginal opening and the inside is the vaginal canal. The upper side facing the sky is the bladder support, and the opposite side facing the ground is the rectum support. The very back of the mailbox would be the apex support for the uterus or the vaginal cuff if one has had a hysterectomy.

Organs will prolapse (fall out) when there is a loss of support (damage to the connective tissue) in the face of either gravity or or an increase in abdominal pressure with exertion. Prolapse is typically worse later in the day after being active, and better first thing in the morning after lying down all night. Symptoms can range from pelvic heaviness or pressure, to subtle discomfort with intercourse to tissue actually buldging past the vaginal opening.

A fallen bladder is called a cystocele. There are two basic types. The first is where the supporting connective tissue (fabric) has been stretched out and allows the bladder to push directly against the vaginal mucosa. The second type is where the connective tissue has torn, either where it attaches to the pelvis called a paravaginal defect, or from the top of the vagina or cervix. Both the bladder and the vagina are made to be stretched so neither one will hold the other in once the supporting tissues have been damaged.

A rectocele occurs when the supporting tissue between the rectum and vagina is compromised. These are a common occurrence as this area takes a beating with childbirth. Difficulties with having a bowel movement can occur with rectocele. When the rectocele bulges far enough out it acts as a reservoir to collect the stool with a bowel movement. The stool follows the path of least resistance which is into the pouch rather than out of the anus. Women will independently discover that they can help themselves have a bowel movement by pressing on the rectocele while they go. This eliminates the reservoir and facilitates normal function. Uterine prolapse occurs when the supporting ring at the top of the vagina is damaged.

Pelvic Floor Patient Education Brochure