Prolapse, a falling down or protrusion of the pelvic organs into or outside the vagina, is common in older women. Pelvic/organ prolapse is also called genital prolapse, pelvic relaxation, and pelvic floor dysfunction. It occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. Generalized weakness and sagging of the pelvic floor, or abnormalities of the pelvic floor muscles can lead to urinary and/or fecal incontinence as well. Pregnancy and childbirth often cause pelvic floor weakening, but sometimes incontinence doesn't show up until a woman is in her mid-forties or later. The decrease in
estrogen after
menopause can further weaken pelvic muscles and tissues. Prolapse also can be related to anything that causes increased pressure in the abdomen, such as obesity, chronic coughs and constipation.
There are several types of pelvic or organ prolapse, and it is not unusual for a woman to have more than one area of prolapse:
- cystocele - a hernia-like disorder in women that occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into or outside of the vagina
- enterocele - this occurs when the muscles and tissues supporting the small bowel weaken, allowing the small bowel to fall and protrude through the vaginal wall
- rectocele - weakening of the tissues and muscles between the rectum and vagina allow the rectum to protrude into the vaginal area
- uterine prolapse - weakened support tissues and muscles allow the uterus (womb) to sag or slip out of its normal position. The uterus may slip enough that it drops partway into the vagina (birth canal), creating a lump or bulge, or in severe cases, partially outside of the vagina
- vaginal vault prolapse - this occurs when the upper wall of the vagina falls down into the vagina. This may happen to women who have had a hysterectomy (removal of the uterus).