Lowering of the pelvic floor and organs

General Information

When the pelvic floor is lowered, a weakness of the pelvic floor muscles causes the pelvic floor including the pelvic floor organs: uterus (uterus), bladder and rectum to be lowered. Normally, the muscles and ligaments in the pelvic floor area hold the organs firmly in position and prevent them from sinking. However, if the muscles and holding ligaments are pressed down, the organs cannot be held either. Lowering of the pelvic floor can also occur after removal of the uterus, in which case the vaginal stump also typically sinks. The probability of suffering a pelvic floor prolapse increases with age and is particularly high during the menopause.

Causes

Pelvic floor prolapse can have various causes. In most cases the pelvic floor is injured during childbirth. Thus, many vaginal births or heavy births are a risk factor for the development of pelvic floor prolapse.

But overweight, weakness of the connective tissue in this area or excessive or chronic stress on the pelvic floor can also be the cause. The regular carrying of heavy objects must also be mentioned here, as carrying them also places chronic strain on the pelvic floor. The occurrence of pelvic floor prolapse during menopause is also typical.

The cause is then the remodelling of the tissue of the pelvic floor. These transformation processes are favoured by the reduced oestrogen production during the menopause. Genetic factors also probably play a role.

A slight lowering of the pelvic floor can initially not cause any symptoms. If, on the other hand, the lowering is more pronounced, there is a strange feeling of loosening or a feeling of pressure in the area of the pelvis. If the sagging is severe, even tissue of the pelvic floor or the uterus can be seen and palpated between the labia.

In this case there is a prolapse of the uterus into the vagina. Usually there is then also a strong foreign body sensation in the area of the vagina. This severe form of pelvic floor prolapse can also lead to other symptoms, such as disturbances during emptying of the bowel and bladder (involuntary discharge of stool or urine) or discomfort during sexual intercourse.

Pain due to irritation of surrounding nerves is also possible. In addition, there may be a premature urge to urinate and thus to go to the toilet (urge incontinence). Even a small filling can lead to the urge to urinate because the bladder is not fixed in place. The quality of life is greatly impaired by this severe form of pelvic floor prolapse.

Diagnosis

An exact medical history should first be taken: the most important factors here are an existing foreign body sensation and pain in the pelvic or vaginal area, the involuntary loss of stool or urine (incontinence) or a feeling of pressure in the lower abdomen. After the anamnesis, an examination is important: here an ultrasound of the pelvis and abdomen can be performed as well as a positional check of the bladder, rectum and uterus, which can also change their position due to the lowering of the pelvic floor. A gynaecological examination of the vagina and possible foreign bodies in this area is also useful.

In addition to the gynaecological examination, a rectal examination via the intestine should also be carried out. The clinical examination can also be used to assess the severity of the pelvic floor prolapse and the possible prolapse of the uterus and to classify it using a score. In complex cases, an MRI for imaging may also be important.