Pelvic Support Problems

A pelvic support problem, also known as pelvic organ relapse, is a condition that affects about one-third of all women. It is a type of pelvic floor disorder in which one or more pelvic organs cannot be supported by tissue and muscles, causing them to slip from their normal position to a lower position in the pelvis. It typically occurs when fibrous pelvic tissues or pelvic muscles stretch, tear or weaken. The pelvic floor is a group of muscles and other tissues that stretch like a hammock from the tailbone to the pubic bone. These muscles and tissues play the role of keeping the pelvic organs in place. Pelvic organs include the uterus, vagina, bladder, rectum, and urethra. These organs may droop or prolapse from their normal position and descend into or outside the anus or vaginal canal.

When the pelvic floor develops problems, one or more of the pelvic organs may stop functioning normally. Pelvic support problems are most common in women who’ve given birth, but can also be caused by various conditions and procedures such as age, constipation, obesity, and hysterectomy. Pelvic support problems can also be associated with conditions such as anal incontinence and urinary incontinence. While pelvic support problems aren’t life-threatening, they can cause significant pain and discomfort.

Types of Pelvic Support Problems

Different pelvic support problems are designated by the pelvic organ that has slipped into the vagina. Often, prolapse in more than one part of the pelvic floor occurs the same time. You may hear pelvic organ prolapse being referred to in these ways:

  • Cystocele (bladder): This is the most common pelvic support problem. It occurs when there’s a weakness in the top wall of the vagina that results in the bladder dropping into the vagina. Some problems associated with a cystocele include incomplete emptying of your bladder or a bulge from your vaginal space.

  • Urethrocele (urethra): An urethrocele is a prolapse of your urethra into the vagina. In some cases, it may be combined with a cystocele or urinary incontinence.

  • Rectocele (rectum): This condition is caused by weakness in the bottom wall of the vagina that causes a protrusion of the rectum into the vaginal space. During bowel movements, you may have difficulty with complete evacuation and may have small, frequent bowel movements.

  • Enterocele (small intestines): An enterocele occurs when the small intestines push against the top wall of the vagina, creating a bulge.

  • Vault Prolapse: The top part of the vagina can droop or fall, especially if you’ve had a hysterectomy. This usually occurs at the same time with an enterocele.

  • Uterine Prolapse (uterus): The uterus may bulge or droop low into the vagina when there’s a weakness in the support of the uterus.

Causes of Pelvic Support Problems

Pelvic support problems develop when the pelvic floor becomes weakened to an extent that it can’t hold pelvic organs in place firmly. This weakening can be caused by a number of things but basically, anything that puts increased pressure on the abdomen can cause this condition. The most common cause of pelvic organ prolapse is pregnancy, labor, and vaginal childbirth, especially if you gave birth to a large baby or multiple babies, or if you had a long, difficult birth. Other common causes include:

  • Aging

  • Going through the menopause

  • Being overweight or obese

  • Repeated heavy lifting

  • Having long-term constipation and straining to have bowel movements

  • Respiratory condition with long-term, chronic coughing

  • Having a hysterectomy (surgical removal of the uterus)

  • Pelvic organ cancers

Genetics may also contribute to prolapse. Women with weaker connective tissues may be at higher risk of experiencing pelvic support problems. Some health conditions can make a pelvic organ prolapse more likely, including:

  • Marfan syndrome

  • Ehlers-Danlos syndrome

  • Joint hypermobility syndrome

Symptoms of Pelvic Support Problems

While some women notice nothing at all, others report having the feeling of “falling down” in the vagina or a sensation of pressure or bulging in the vagina. Symptoms of pelvic support problems can range from mild to severe and can include:

  • A feeling of pressure, fullness, heaviness, bulging sensation, pelvic heaviness, or something falling out of the vagina. It gets worse during a bowel movement or by the end of the day

  • A visible bulge of the pelvic organs outside of your vagina

  • Low back pain

  • Having a hard time starting to urinate or emptying your bladder completely

  • Feeling pain while urinating

  • Difficulty with bowel movements

  • Urinary incontinence

  • Chronic urge to urinate

  • Being constipated

  • Leaking stool or having a hard time controlling gas

  • Leaking urine when you laugh, cough, or exercise

  • Having a hard time making it to the bathroom in time

  • Painful intercourse

  • Spotting or bleeding from the vagina

Symptoms of pelvic support disorders somewhat depend on the organ involved. For instance, if the rectum prolapses, uncomfortable intercourse, and constipation often occur. If it’s the bladder, chronic urge to urinate or urine leakage may occur. Uncomfortable intercourse or a backache in the low back often accompanies small intestine prolapse or uterine prolapse. Symptoms may worsen at a certain time, such as just prior to menstruation, after standing for long periods or at the end of a long day.

Diagnosis of Pelvic Support Problems

Diagnosis of pelvic support systems begins with your OB-GYN taking your medical history and conducting a pelvic exam. This can help determine the type of prolapse you’re experiencing, such as rectum, bladder, or uterine. Your OB-GYN may ask you to bear does and push as you would during a bowel movement to see if any of your pelvic organs bulge into the vagina. You may also be asked to squeeze your pelvic muscles to see how strong they are. A pelvic exam may be done in different positions, standing, lying down, or squatting.

Some tests might also be needed. These may include:

  • Pelvic floor strength tests: This test involves your doctor examining the strength of your pelvic floor and sphincter muscles. Your doctor will test the strength of muscles and ligaments that support the uterus, bladder, vaginal walls, urethra, and rectum.

  • Bladder function test: This test is as simple as determining whether your bladder leaks following readjustment to normal position at the time of your physical exam. Some tests might be done to measure how well your bladder empties. The results of these tests can help determine the most appropriate treatment option and management for prolapse.

  • Ultrasound: Ultrasound will use high-frequency sound waves to create detailed images of your bladder, kidneys, and the muscles around your anus. This imaging method is useful only in complex cases.

  • Magnetic resonance imaging (MRI): This imaging method will use a magnetic field and radio waves to produce images of your pelvis. Just as with ultrasound, MRI is useful only in complex cases.

Treating Pelvic Support Problems

Treatment for pelvic support problems typically depends on how severe the symptoms are. If the pelvic support problem doesn’t bother you, non-surgical treatment may be recommended. If the condition is severe and significantly affects your quality of life, surgical strategies might be needed. Pelvic support problems often affect more than one area. For instance, if one of your pelvic organs is prolapsed, chances are that you’ll develop another form of pelvic organ prolapse. At GYNLA, we try to correct all pelvic support problems at on time.

Treatment options include:


Certain women with prolapse might be treated with estrogen. This is preferable for women in menopause because they experience lower estrogen levels, which can lead to vaginal dryness and can weaken pelvic floor muscles. Some women below the menopause age can be treated with estrogens before surgery. However, there are women who cannot be treated with systemic use of estrogen. The use of vaginal estrogen generally doesn’t pose a risk, but we’ll discuss the risks and benefits with you before administering this treatment.

Physical Therapy

Our specialists might recommend physical therapy with pelvic floor exercises (Kegels). These exercises involve tightening the muscle as you would hold urine when peeing, which will pull the rectum and vagina up and back. We also use biofeedback to strengthen particular muscles of the pelvic floor. This involves the use of devices with sensors that are placed on your skin or in your vagina or rectum. As you squeeze the muscles, a computer screen shows whether you’re using the right muscles as well as the strength of each contraction. This is meant to help you learn how to do Kegel exercises with proper abdominal control and breathing techniques. Long-term strengthening of these muscles might improve your prolapse or make the symptoms disappear altogether. Biofeedback teaches you how to use your own muscles to strengthen them.


This is a treatment option for some women who might prefer a nonsurgical alternative to treat pelvic organ prolapse. A pessary is a soft plastic device that looks like a ring and comes in several different shapes and sizes. The device is inserted into the vagina to support or hold up your uterus, bladder, or rectum. Being fitted with a pessary is similar to being fitted for a diaphragm birth control. Fitting occurs during an office visit and typically takes less than 10 minutes. The pessary can also be used as a temporary option to provide comfort until surgery takes place.


If non-surgical treatments haven’t helped reduce severe symptoms of pelvic organ prolapse, you may want to consider surgery to reposition the prolapsed organs and/or repair the pelvic floor muscles. At GYNLA, we use various vaginal approaches and other minimally invasive or laparoscopic surgery to treat some types of pelvic support problems. Laparoscopic surgery allows your surgeon to make minimal incisions through the lower abdomen or the vagina. The benefit of this surgery is that patients usually have less pain and can also shorten your hospital stay. You can also carry out all but strenuous activities in 10-14 days.

Laparoscopic pelvic reconstructive surgery carries the principles and techniques similar to those used for abdominal surgery. This surgery can, therefore, be used to repair vaginal prolapse, uterine prolapse (with or without hysterectomy), bladder prolapse, and enteroceles. However, the repair of rectal prolapse is not yet well suited to laparoscopic surgery.

There are different surgical strategies that may be applied based on the location of your prolapse:

Anterior prolapse (cystocele): This often involves the bladder. You surgeon pushes your bladder up and keeps it in its proper position by securing the connective tissues between your vagina and bladder. Excess tissue is also removed. If you have urinary incontinence, your OB-GYN might recommend a sling or bladder neck suspension to support your urethra.

Posterior prolapse (rectocele): This often involves the rectum. During the surgery, the connective tissue is secured between the rectum and vagina in order to reduce the size of the bulge. Excess tissue is removed.

Uterine prolapse: If you don’t plan to have children in the future, your uterine prolapse might be corrected by removing the uterus (hysterectomy).

Vaginal vault prolapse: The prolapse for women who have had a hysterectomy is usually at an apical prolapse or at the apex. Vaginal vault prolapse might involve the rectum, bladder, and, commonly, the small bowel where the prolapse if known as enterocele. Corrective surgery might be performed through the vagina or abdomen.

The type of surgery done through the vaginal approach is called Sacrospinous Fixation. Your own ligaments are used to suspend or correct the sagging pelvic organs. Your surgeon will make incisions in the vagina and use stitches to attach the vault to ligaments in the pelvic floor. Pelvic reconstructive surgery done through the abdomen is called Sacral Colpopexy. It might be performed robotically, laparoscopically, or as an open procedure. This type of surgery involves your surgeon attaching the vagina to the tailbone and might use small portions of synthetic surgical mesh to help support vaginal tissues and lift sagging organs into place. If you’re concerned with the use of mesh materials, we can discuss your options as well as the benefits and potential risks.

The care team at GYNLA will help you choose a treatment option that best serves you and your overall needs.

Finding an OB-GYN for Pelvic Support Problems Near Me

At GYN LA, our specialists are passionate about improving the quality of life. If you’re exhibiting symptoms of pelvic support problems, we encourage you to schedule an appointment with us. At your initial office visit, one of our OB-GYN will evaluate your medical history, do a physical examination (including a pelvic exam) and perform a bladder emptying check and urine test. After the specific problem(s) is identified, your doctor will guide you through the treatment options and outcomes.

Contact our Los Angeles OBGYN today at 310-375-8446.