Pelvic Organ Prolapse and Incontinence 

If you feel the urge to urinate, have difficulty emptying your bladder, or notice the presence of protruding tissue in your vagina (which many women describe as feeling like a ball), you could be experiencing pelvic organ prolapse. 

Prolapse with or without prominent symptoms is more common than you might think. Below will focus on the types of prolapse that can lead to urine leakage issues. 

What is pelvic floor prolapse?

The pelvis is located between the hips and below the navel. It holds several organs: the bladder, cervix, intestines, rectum, urethra, uterus, and vagina. Pelvic organ prolapse can occur in any organ in the pelvis and occurs when the pelvic muscles weaken to the point that they can no longer support the organ, and it slips into the vagina. The resulting symptom is tissue protruding from the genital area.

The likelihood of prolapse increases with age. A known cause of prolapse is childbirth; the more frequent births, the higher the risk. Excessive exercise from repeated heavy lifting and long-term illness with coughing and constipation can also increase the risk of prolapse.

Symptoms 

Symptoms of a prolapse depend on the type and severity and can occur gradually or suddenly. Protrusion of tissue from the vagina with tenderness and bleeding is the most distinctive symptom of prolapse. Below are examples of different types of prolapse and the symptoms they can cause in the bladder and bowel. 

Rectocele:

Rectocele is a condition involving a prolapsed bowel where the wall of tissue separating the rectum and vagina weakens, forming a bulge in the rectum and protruding against the vaginal canal. Symptoms include:

• Constipation
• The sensation that you cannot empty the bowel
• Feeling pressure within the pelvis
• A bulging mass felt inside the vagina

To aid bowel movement, consider manually pushing the perineum (the area between the vagina and rectum). This is referred to as "digital evacuation."

Cystocele:

Cystocele prolapse occurs when the bladder falls and is pushed into the vaginal cavity. Symptoms may include:

• Difficulty emptying the bladder when urinating
• Urinate frequently
• Large/Bulging mass felt inside the vagina

Difficulty emptying the bladder and feelings of urgency typically arise from the prolapse compressing the urethra. Urinary tract infections commonly occur in conjunction with this condition because the bladder cannot empty and leaves bacteria behind. Women may find that symptoms are less severe in the morning. When the body is lying horizontally (lying in bed), it reduces the symptoms. However, the symptoms will return when the pelvic floor is subjected to stress from daily activities.

Every case is different. If you are struggling with urgency, unknown bleeding, bulging or any of the above, discuss it with your healthcare professional. If you are experiencing severe problems, such as needing to urinate but are unable to do so, you may need more urgent acute care.

Treatment of Pelvic Organ Prolapse

Proper diagnosis of the type of pelvic organ prolapse requires a physical examination by a physician. Your symptoms will be reviewed, and other relevant testing may be necessary to properly diagnose what type of prolapse you are experiencing. After diagnosis, doctors can determine a suitable treatment plan.

Mild cystocele cases that do not cause pain or discomfort may not need medical treatment. However, your doctor may recommend avoiding heavy lifting and increasing fibre and fluids to prevent constipation. In addition, pelvic floor exercises such as Kegels will help strengthen the pelvic floor muscles and are recommended as a preventive measure for all women, regardless of whether they have prolapse symptoms. 

Severe cases may require surgical and non-surgical treatment methods (such as pessaries or estrogen replacement therapy).

Prolapse and Incontinence

One of the more common complications associated with prolapse is incontinence. Urinary incontinence may occur due to the weakening of the pelvic floor muscles, which help control urination and protect organs from prolapsing. In addition, constipation or fecal leakage may occur if the prolapse also involves the bowel. Below are bladder and bowel issues associated with pelvic organ prolapse:

• Stress urinary incontinence. Urinary leakage during sneezing, laughing, or physical activity (such as lifting heavy objects).
• Urge incontinence. Involuntary urinary leaks following a sudden, strong urge to urinate.
• UTI. Bacteria infects the urinary tract, causing symptoms such as incontinence, painful urination, and traces of blood in the urine. 
• Bowel incontinence. The inability to control bowel movements which can cause fecal leakage. In the case of rectal prolapse, constipation and difficulty emptying the bowel are often the cause.
• Anal prolapse is a condition when the bowel comes out of the rectum and causes fecal incontinence (common in older people).