Pelvic Floor Prolapse & Uterine Prolapse | Symptoms & Treatment

The pelvic floor refers to the lower part of the pelvic canal. Here, the pelvic floor muscles form the foundation that supports the internal abdominal and pelvic organs from below and stabilizes them in their proper position. The pelvic floor muscles work closely with surrounding structures to support the organs. The pelvic floor muscles also stabilize the urethra, ensuring that the bladder’s closure mechanism functions properly.

Furthermore, the pelvic floor muscles are particularly important for continence, as they support the sphincter muscles of the bladder and anus in their function.

Being overweight, heavy lifting, and a family history of connective tissue weakness are considered significant risk factors for prolapse. The pelvic floor, as a muscular structure, can be weakened by pregnancy and childbirth. Persistent straining, such as during constipation, can further weaken the pelvic floor. Chronic strain caused by recurring constipation or persistently elevated pressure further exacerbates the weakening of the pelvic floor. Hormonal changes during menopause can weaken the connective tissue. Severe or frequent coughing can exert additional pressure on the pelvic floor and contribute to prolapse.

The weakened pelvic floor is no longer able to fully perform its function, so that initial problems with bladder emptying usually occur first. This results in dribbling or even urinary incontinence.

As the condition progresses, the uterus descends, pushing other pelvic organs—such as the vagina and, above it, the bladder and rectum—downward. If the organs protrude beyond the vulva, this is referred to as partial prolapse or, ultimately, total prolapse. Medically, this condition is referred to as prolapse.

Weakness of the pelvic floor often manifests as increasing discomfort during movement. Depending on its severity, pelvic floor prolapse can lead to various symptoms. Initially, there is often a sensation of a foreign body in the vagina, as well as incomplete emptying of the bladder or rectum, which can also cause problems with bowel movements. Many affected individuals also report a feeling of pressure in the pelvic area.

Bladder weakness with frequent urination and recurring urinary tract infections occur because the bladder often cannot be completely emptied. Urinary incontinence can develop as a result of pelvic floor weakness. As the condition progresses, general incontinence may develop if the stability of the pelvic organs continues to decline.

If symptoms worsen or significantly interfere with daily life, surgery is usually recommended.

Alternatively, the use of a so-called pessary is also an option. A pessary is a plastic device (disc, ring, or cube) that is inserted into the vagina to lift the structures upward. Since inserting and removing it from the vagina is often painful, it is usually only a temporary solution.

Uterine prolapse resulting from pelvic floor prolapse © Henrie #59249822 | AdobeStock

When diagnosing pelvic floor prolapse, the patient’s medical history is important because it provides initial clues about the condition and the symptoms. Key questions concern symptoms related to urination (urinary incontinence) as well as possible symptoms of fecal incontinence, pain during sexual intercourse, or general pain in the pelvic floor area.

The gynecological examination plays a central role in determining the severity of the prolapse. Medically, a distinction is made between different severity levels, ranging from Grade 1 (mild prolapse) to Grade 3 (significant displacement of the organs). The physical examination includes a vaginal examination and, if necessary, a rectal examination. This allows for the objective assessment of organ prolapse and, if applicable, the detection of abnormalities in pelvic floor or anal reflexes. 

In some cases, the diagnosis is supplemented by a bladder function test (urodynamics) or a cystoscopy.

Targeted pelvic floor exercises can significantly alleviate symptoms and improve muscle function.

So-called biofeedback devices can be used in this process; with their help, patients learn to locate the pelvic floor and engage it specifically for the exercises.

If exercise alone is not sufficient or if the pelvic organ prolapse is already too advanced, conservative treatment with a pessary (see above) is possible, or surgery may ultimately be an option. What all available procedures have in common is that the prolapsed pelvic organs are repositioned and secured in place.

The surgical method depends on the findings. It is usually necessary to secure the uterus, vagina, or cervix in an upward position. Specialists refer to this as the middle compartment. If, after correcting this area, the anterior or posterior wall of the vagina remains prolapsed, these areas should also be corrected (anterior vaginoplasty or posterior vaginoplasty).

If the uterus, vagina, or cervix are lifted, they are usually secured to the coccyx or sacrum. Today, this is performed via laparoscopy, without the need for a large abdominal incision. Synthetic mesh is used for this purpose. However, since synthetic mesh can cause significant side effects, it has already been banned in some countries (for example, in the United States). It is now also possible to use the body’s own tendon tissue, which appears to work just as well as synthetic mesh. 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 sacrospinal fixation via a vaginal procedure. In this procedure, the vagina is secured in the area of the pelvic ligaments. A disadvantage is that the vagina is pulled to one side (usually to the right).

Prolapse problems can also occur after a hysterectomy, as important supportive structures are missing.

Pelvic floor weakness and prolapse may be prevented through preventive pelvic floor exercises or pelvic floor therapy under the experienced guidance of a therapist. In most cases, however, this is only temporarily effective.

It is also recommended to maintain a healthy body weight, opt for a planned cesarean section in cases of large babies, and avoid regularly lifting particularly heavy loads.

Pelvic organ prolapse falls within the scope of gynecology and obstetrics. Colleagues from the fields of urology and proctology are often involved as well. When searching for suitable specialists or clinics, look for those with experience treating “pelvic organ prolapse.”

1. What is pelvic organ prolapse?
Pelvic organ prolapse occurs when the pelvic floor muscles are weakened and the internal organs slip downward. As a result, the uterus, bladder, or bowel may descend toward the vagina or protrude.

2. What are the typical symptoms?
Those affected often report a sensation of a foreign object in the vagina, difficulty emptying the bladder or bowel, bladder weakness, recurrent urinary tract infections, or urinary incontinence.

3. How is pelvic organ prolapse treated?
Targeted pelvic floor exercises are recommended as a first step. If this is not sufficient or if the prolapse is advanced, a pessary or various surgical procedures may be used to lift and stabilize the organs.

4. Can pelvic organ prolapse be prevented?
Yes, regular pelvic floor exercises, maintaining a healthy body weight, and avoiding heavy physical strain can reduce the risk. For high-risk patients, a planned cesarean section can also relieve pressure on the pelvic floor.