The pelvic floor is the lower part of the pelvic canal. Here, the pelvic floor muscles form the basis for securing the internal abdominal and pelvic organs downwards and stabilizing them in their position.
The muscles of the pelvic floor are also particularly important for continence, as they support the sphincter muscles of the bladder and anus in their work.
The pelvic floor as a muscular structure can be weakened by pregnancy, childbirth, heavy lifting and obesity. Hereditary weakness of the connective tissue also often leads to pelvic floor prolapse.
The weakened pelvic floor is no longer able to fully perform its function, which usually leads to initial problems with urination. This results in dribbling or even urinary incontinence.
As the disease progresses, the uterus descends, pushing down other pelvic organs such as the vagina and, lying on top of it, the bladder and rectum. If the organs protrude in front of the vulva, this is referred to as partial or eventually total prolapse.
Pelvic floor prolapse can lead to different symptoms depending on its severity. Initially, there is often a foreign body sensation in the vagina and incomplete emptying of the bladder or rectum.
Bladder weakness with frequent urination and recurrent bladder infections are also described. Urinary incontinence can develop due to pelvic floor weakness.
If the symptoms increase or severely affect those affected in their everyday life, they are usually advised to have an operation.
Alternatively, the use of a so-called pessary is also possible. A pessary is a plastic object (disk, ring or cube) that is inserted into the vagina to push the structures upwards. As insertion and removal from the vagina is often painful, it is usually only a temporary solution.
Uterine prolapse due to pelvic floor prolapse © Henrie #59249822 | AdobeStock
The medical history is important for the diagnosis of pelvic floor prolapse, as it provides initial information about the condition and the symptoms. Important questions concern complaints during urination (urinary incontinence), pain during sexual intercourse or general pain in the pelvic floor area.
Finally, the physical examination includes a vaginal and, if necessary, rectal examination. This allows the prolapse of the structures to be objectified and any reflex disorders in the pelvic floor or anal area to be detected.
In individual cases, the diagnosis is supplemented by a measurement of bladder function (urodynamics) or cystoscopy.
The primary aim is to train and strengthen the pelvic floor with the help of targeted pelvic floor training.
So-called biofeedback devices can be used to help those affected learn to localize the pelvic floor and respond specifically to the exercises.
If training alone is not enough or if the pelvic floor prolapse is already too advanced, conservative treatment with a pessary (see above) or surgery is an option. What all available procedures have in common is that the lowered pelvic organs are repositioned and fixed in place.
The surgical method depends on the findings. It is usually necessary to secure the uterus, vagina or cervix upwards. The specialist refers to this as the middle compartment. If the anterior or posterior wall of the vagina remains lowered after this area has been corrected, these areas should also be corrected (anterior vaginoplasty or posterior vaginoplasty).
If the uterus, vagina or cervix are raised, they are usually attached to the coccyx or sacrum. Nowadays, this can be done via laparoscopy without the need for a large abdominal incision. Plastic meshes are used for this. However, as plastic meshes can cause considerable side effects, plastic meshes have already been banned in some countries (for example in the USA). It is now also possible to use the body's own tendon tissue, which seems to work just as well as plastic meshes. In knee surgery, there are decades of experience with this tissue, which has been used there for decades to replace the anterior cruciate ligament.
Another method is sacrospinous fixation via an operation through the vagina. Here, the vagina is fixed in the area of the pelvic ligaments. One disadvantage is that the vagina is distorted to one side (usually to the right).
Pelvic floor weakness and pelvic floor prolapse can possibly be prevented by preventative pelvic floor training or pelvic floor exercises under the experienced guidance of a therapist. However, this is usually only temporarily successful.
It is also advisable to maintain a healthy body weight, choose a planned caesarean section for heavy children and avoid lifting particularly heavy loads on a regular basis.
Pelvic floor prolapse belongs to the field ofgynecology. Colleagues from urology and proctology are often also involved. When searching for suitable specialists or clinics, make sure they have experience with the clinical picture of pelvic floor prolapse.
